IndividualActive
Michael Moore, M.D., P.C.
NPI 1306064860 · Plastic and Reconstructive Surgery Physician · Idaho Falls, ID
Provider details
- NPI number
- 1306064860
- Entity type
- Individual
- Primary specialty
- Plastic and Reconstructive Surgery PhysicianAllopathic & Osteopathic Physicians
- Credential
- M.D., P.C.
- Sex
- Male
- Sole proprietor
- Yes
- License
- M-8270 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
2860 Channing Way
Suite 213
Idaho Falls, ID 83404-7531
Phone: (208) 552-1406
Fax: (208) 552-1416
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 1769
Idaho Falls, ID 83403-1769
Registry dates
- Enumerated
- 2007-04-23
- Last updated
- 2023-03-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.