Individual
DR. MITCHELL JACKSON MOFFITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
775 POLE LINE RD W, SUITE 111, TWIN FALLS, ID 83301-5814
(208) 814-8000
(208) 733-9402
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M-10017
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807839500
—
ID
Enumeration date
10/16/2006
Last updated
01/07/2015
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