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“Aerospace Medicine Physician” (Mountain Home Afb, ID)

Location: Mountain Home Afb, ID
Taxonomy: Aerospace Medicine Physician.

A provider can have more than one taxonomy code. It is critical to register all applicable taxonomy codes with NPPES and to use the correct taxonomy code to represent the specific specialty when filing claims. This will assist in more accurate and timely processing of claims.
1639527096 — DR. IVAN D PETRICH DO
Practice Location Address:
90 HOPE DR
MOUNTAIN HOME AFB ID
83648-1057
Practice Phone: 208-828-7900
1992780597 — DR. RANDALL JAY MOORE M.D., M.P.H., C.P.E
Practice Location Address:
366MDG/SGPF 90 HOPE DRIVE; BLDG 6000
MOUNTAIN HOME AFB ID
83648
Practice Phone: 208-828-7401

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