Healthcare Provider Details

I. General information

NPI: 1679146229
Provider Name (Legal Business Name): DUSTIN JAMES MOYER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 E RIVERPARK LN STE 110
BOISE ID
83706-4000
US

IV. Provider business mailing address

10400 W OVERLAND RD
BOISE ID
83709-1433
US

V. Phone/Fax

Practice location:
  • Phone: 208-361-3668
  • Fax:
Mailing address:
  • Phone: 208-361-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO61543405
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number9371586
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: