Organization Name: | DEER POINT FAMILY PRACTICE PC |
NPI Number: | 1134342264 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GARY A TUBBS (OWNER) |
Mailing Address: | 6023 N Eagle Rd Boise |
State: | ID US |
Postal Code: | 837130997 |
Phone Number: | 2083227284 |
Fax Number: | 2083239070 |
NPI Enumeration Date: | 04/10/2007 |
NPI Last Update Date: | 12/21/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |