DEER POINT FAMILY PRACTICE PC NPI 1134342264

NPI Information

NPI: 1134342264
Provider Name: DEER POINT FAMILY PRACTICE PC
Classification: General Practice - 208D00000X
Entity Type: Organization
Address:
6023 N EAGLE RD
BOISE, ID
ZIP 83713
Phone: (208) 322-7284
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DEER POINT FAMILY PRACTICE PC is a general practice in Boise, ID. DEER POINT FAMILY PRACTICE PC NPI is 1134342264. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6023 N EAGLE RD
BOISE, ID
ZIP 83713-997
Phone: (208) 322-7284
Fax: (208) 323-9070

The provider's authorized official is Gary A Tubbs .
The authorized official title is Owner and has the following contact phone number (208) 322-7284.

The enumeration date for this NPI number is 4/10/2007 and was last updated on 12/21/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000010028455	OTHER	IDAHO	REGENCE BLUE SHIELD OF ID
2	002643400	MEDICAID	IDAHO
3	1378016	MEDICARE PIN	IDAHO
4	080155879	MEDICARE PIN	IDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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