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General NPI Number Information
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NPI Number | 1356320915
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Entity Type | Individual
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Provider Name | HAROLD GUY MOORE MD
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Gender | Male
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 1880 W JUDITH LANE
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City | BOISE
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State | ID
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Zip | 83705-5221
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Country | US
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Telephone | 208-302-5200
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Fax | 208-302-5225
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Provider Business Mailing Address
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Address Line | 3340 E GOLDSTONE WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-1026
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Country | US
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Telephone | 208-302-5200
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Fax | 208-302-5225
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M-12305
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License Number State | ID
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