Individual
TIMOTHY RICHARD MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 W. FORT ST., #111, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Mailing address
500 W FORT ST # 111, BOISE, ID 83702-4501
(208) 422-1000
(208) 422-1319
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
M-12911
ID
207RC0000X
Cardiovascular Disease Physician
M0189
TX
207RI0011X
Interventional Cardiology Physician
M-12911
ID
Other
Enumeration date
06/22/2006
Last updated
02/15/2022
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