Individual
DALE L MOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10798 W. OVERLAND RD, BOISE FAMILY MEDICINE CENTER, BOISE, ID 83709-1329
(208) 377-3368
(208) 322-4691
Mailing address
10798 W. OVERLAND RD, BOISE FAMILY MEDICINE CENTER, BOISE, ID 83709-1329
(208) 377-3368
(208) 322-4691
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M3211
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010004262
BLUE SHIELD
ID
05
—
002643300
—
ID
01
—
080086509
RAILROAD MEDICARE
ID
01
—
080086509
MEDICARE RAILROAD
—
01
—
34611
BLUE CROSS
ID
Enumeration date
08/11/2006
Last updated
09/10/2010
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