Dr. Michael Kirk Moore JR.
Plastic and Reconstructive Surgery
2860 Channing Way Suite 213
Idaho Falls
, Idaho 83404-7531
Dr. Michael Kirk Moore JR.
Plastic and Reconstructive Surgery
2860 Channing Way Suite 213
Idaho Falls
, Idaho 83404-7531
(208) 552-1416
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About
Features
Specialties
- Plastic and Reconstructive Surgery
Languages spoken
- English
Location
First Address
- Dr. Michael Kirk Moore JR.
- Po Box 1769
- Idaho Falls, ID
- Zip : 83403-1769
- Fax : (208) 552-1416
- Phone : (208) 552-1406
Second Address
- Dr. Michael Kirk Moore JR.
- 2860 Channing Way Suite 213
- Idaho Falls, ID
- Zip : 83404-7531
- Fax : (208) 552-1416
- Phone : (208) 552-1406
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2086S0122X | Plastic and Reconstructive Surgery | M-8270 | ID |
National Provider Identifier
| NPI | 1306064860 |
|---|---|
| Provider Name | Dr. Michael Kirk Moore JR. |
| First Address | Idaho Falls, ID 83403-1769 |
| Second Address | Idaho Falls, ID 83404-7531 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 23/04/2007 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 58MKM02 | WY ST BOARD OF PHARMACY (01) | WY |
| 5959620-1205 | UT MEDICAL LICENSE (01) | UT |
| 5959620-8905 | UT ST BOARD OF PHARMACY (01) | UT |
| 6687A | WY MEDICAL LICENSE (01) | WY |
| BM4151849 | DEA (01) | ID |
| CS9201 | ID ST BOARD OF PHARMACY (01) | ID |
| F95588 | (02) | ID |
| M-8270 | MEDICAL LICENSE, ID (01) | ID |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.