Provider Demographics
NPI:1689602914
Name:MOORHOUSE, AARON DREW (DO)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:DREW
Last Name:MOORHOUSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4740 N PENNGROVE WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7446
Mailing Address - Country:US
Mailing Address - Phone:208-938-3663
Mailing Address - Fax:208-938-3663
Practice Address - Street 1:4740 N. PENNGROVE WAY
Practice Address - Street 2:STE. 100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646
Practice Address - Country:US
Practice Address - Phone:208-938-3663
Practice Address - Fax:208-938-3664
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805459700Medicaid
ID1302320Medicare ID - Type Unspecified
ID805459700Medicaid