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Individual

DR. MARK OWEN MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
999 N CURTIS RD, SUITE 117, BOISE, ID 83706-1336
(208) 367-2155
Mailing address
990 E WINDING CREEK DR, EAGLE, ID 83616-7231
(303) 587-7090

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
M-12018
ID

Other

Enumeration date
04/09/2008
Last updated
08/19/2013
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