Dale L Mock, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M3211 Issued in ID

Practice address

10798 W. Overland Rd
Boise Family Medicine Center
Boise, ID 83709-1329

Phone

(208) 377-3368

Fax

(208) 322-4691

NPI assigned

Aug 11, 2006

Last updated

Sep 10, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Boise Family Medicine Center

  • Family Medicine Physician
  • Boise, ID
  • NPI 1376747790
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284076800000",
    "number": "1215948351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10798 W. OVERLAND RD",
            "address_2": "BOISE FAMILY MEDICINE CENTER",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091329",
            "telephone_number": "208-377-3368",
            "fax_number": "208-322-4691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10798 W. OVERLAND RD",
            "address_2": "BOISE FAMILY MEDICINE CENTER",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091329",
            "telephone_number": "208-377-3368",
            "fax_number": "208-322-4691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOCK",
        "first_name": "DALE",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2010-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M3211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010004262",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "080086509",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002643300",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "34611",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080086509",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fatuma Y Mnongerwa
• Sebastian Moad, LCSW
• Melanie Moats, COTA
• William Moats, PT
• Mobileonedocs, LLC
• Joycelyn Modica, PT
• Jessie Modlin, PHARMD
• Bevin Jay Modrak, LCPC
• Kelsey Eileen Moe, PCP-NP
• Tawnya M Moeller, CST

• Family Medicine Physician in Boise, ID
• Providers in Boise, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.