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1508514456
TAKAHISA KOIDE
NAMPA, ID
NPI
1508514456
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: ID PA-2208)
Enumeration Date
2022-03-10
Last Update Date
2022-03-10
Business Address
TAKAHISA KOIDE PA
700 CALDWELL BLVD
NAMPA, ID 83651-1707
Phone number: 208-466-6567
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Mailing Address
TAKAHISA KOIDE PA
PO BOX 191050
BOISE, ID 83719-1050
Phone number: 208-955-6500
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