Organization
BOISE FAMILY MEDICINE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE L MOCK M.D. (OWNER/PHYSICIAN)
(208) 377-3368
Entity
Organization
Contact information
Practice address
10798 W. OVERLAND RD, BOISE, ID 83709-1329
(208) 377-3368
(208) 322-4691
Mailing address
10798 W. OVERLAND RD, BOISE, ID 83709-1329
(208) 377-3368
(208) 322-4691
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006306
BLUE SHIELD
ID
05
—
002643200
—
ID
01
—
32110
BLUE CROSS
ID
Enumeration date
06/11/2007
Last updated
09/08/2010
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