Healthcare Provider Details

I. General information

NPI: 1992600126
Provider Name (Legal Business Name): RIVERSIDE FOOT AND ANKLE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
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 TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DUSTIN MOYER
Title or Position: OWNER
Credential: DPM
Phone: 208-361-3668