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General NPI Number Information
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NPI Number | 1932398310
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Entity Type | Individual
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Provider Name | DR. DANE MOSHER
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Gender | Male
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 8880 N HESS ST UNIT 1
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City | HAYDEN
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State | ID
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Zip | 83835-8741
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Country | US
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Telephone | 208-772-5204
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Fax |
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Provider Business Mailing Address
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Address Line | 6848 N GOVERNMENT WAY STE 114 PMB 9
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City | DALTON GARDENS
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State | ID
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Zip | 83815-7799
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Country | US
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Telephone | 512-222-3263
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Fax |
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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-1644
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License Number State | ID
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