Individual
DR. MICHAEL KIRK MOORE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., P.C.
Contact information
Practice address
2860 CHANNING WAY, SUITE 213, IDAHO FALLS, ID 83404-7531
(208) 552-1406
(208) 552-1416
Mailing address
PO BOX 1769, IDAHO FALLS, ID 83403-1769
(208) 552-1406
(208) 552-1416
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
M-8270
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58MKM02
WY ST BOARD OF PHARMACY
WY
01
—
5959620-1205
UT MEDICAL LICENSE
UT
01
—
5959620-8905
UT ST BOARD OF PHARMACY
UT
01
—
6687A
WY MEDICAL LICENSE
WY
01
—
CS9201
ID ST BOARD OF PHARMACY
ID
01
—
M-8270
MEDICAL LICENSE, ID
ID
Enumeration date
04/23/2007
Last updated
03/07/2023
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