| NPI | 1376574442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA A. MALLOY Executive Secretary 208-463-3103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207N00000X Dermatology |
| 207R00000X Internal Medicine | |
| 204C00000X Neuromusculoskeletal Medicine, Sports Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 207W00000X Ophthalmology | |
| 207X00000X Orthopaedic Surgery | |
| 207Y00000X Otolaryngology | |
| 208000000X Pediatrics | |
| 208600000X Surgery | |
| 207RP1001X Internal Medicine, Pulmonary Disease | |
| 207RR0500X Internal Medicine, Rheumatology | |
| 208100000X Physical Medicine & Rehabilitation | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2012-06-27 |