Individual
DR. RICHARD E MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6156 W EMERALD STREET, BOISE, ID 83704-8613
(208) 377-0777
(208) 377-1070
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 377-0777
(208) 377-1070
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M5456
ID
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
M5456
ID
Other
Enumeration date
06/21/2006
Last updated
04/07/2015
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