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Individual

DR. DARRYL G MOFFETT JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3544 E 17TH ST, SUITE 105, AMMON, ID 83406-6911
(208) 535-4900
(208) 535-4906
Mailing address
3544 E 17TH ST, SUITE 105, AMMON, ID 83406-6911
(208) 535-4900
(208) 535-4906

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M-6263
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
002726100
ID
Enumeration date
06/11/2006
Last updated
08/13/2015
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