NPI age
19 years
Enumerated 2007-04-23
● Active
Type 1 · Individual
DR. Michael Kirk Moore JR., M.D., P.C.
Moore is 1 of 4 surgery providers in Idaho Falls and 1 of 24 in Idaho.
Primary specialty
Surgery
Licensed in
ID
1 state
Status
Active
No deactivations on record
Last NPPES update
2023-03-07
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 24 active surgery providers in Idaho.
NPI age
19 years
≈ at median (18 yr)
State licenses
1 state
4% of peers hold multiple states
Subspecialties
0
20% of peers hold subspecialties
NPI lifetime · 2007 → 2026
2007-04Enumerated in NPPES
2007
2026
Where they practice
Practice location
2860 Channing Way, Suite 213
Idaho Falls, ID 834047531
Mailing address
Po Box 1769
Idaho Falls, ID 834031769
Specialties
-
Surgery PrimaryA surgeon who specializes in plastic and reconstructive surgery.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | M-8270 | MEDICAL LICENSE, ID |
| 01 (UT) | 5959620-1205 | UT MEDICAL LICENSE |
| 01 (WY) | 58MKM02 | WY ST BOARD OF PHARMACY |
| 01 (UT) | 5959620-8905 | UT ST BOARD OF PHARMACY |
| 01 (WY) | 6687A | WY MEDICAL LICENSE |
| 01 (ID) | CS9201 | ID ST BOARD OF PHARMACY |
Practice context
Part of a multi-provider practice. 21 other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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