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General NPI Number Information
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NPI Number | 1689602914
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Entity Type | Individual
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Provider Name | AARON DREW MOORHOUSE DO
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 01/20/2020
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Provider Practice Location Address
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Address Line | 4740 N. PENNGROVE WAY STE. 100
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City | MERIDIAN
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State | ID
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Zip | 83646
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Country | US
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Telephone | 208-938-3663
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Fax | 208-938-3664
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Provider Business Mailing Address
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Address Line | 4740 N PENNGROVE WAY STE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-7446
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Country | US
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Telephone | 208-938-3663
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Fax | 208-938-3663
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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 | O-242
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License Number State | ID
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