Individual
DR. RANDALL JAY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., M.P.H., C.P.E
Contact information
Practice address
366MDG/SGPF, 90 HOPE DRIVE; BLDG 6000, MOUNTAIN HOME AFB, ID 83648
(208) 828-7401
Mailing address
PO BOX 1338, MCCALL, ID 83638-1338
(808) 772-0871
Taxonomy
Speciality
Code
Description
License number
State
2083A0100X
Aerospace Medicine Physician
17958
AZ
2083A0100X
Aerospace Medicine Physician
4463
MT
2083A0100X
Aerospace Medicine Physician
Primary
M-4332
ID
Other
Enumeration date
12/07/2005
Last updated
05/29/2018
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