Individual
RYAN A MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11197 W FAIRVIEW AVE, BOISE, ID 83713-7935
(208) 378-8011
(208) 322-8095
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6522
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-10137
ID
207Q00000X
Family Medicine Physician
MR-0869
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807490300
—
ID
Enumeration date
07/20/2006
Last updated
09/23/2014
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