| Doctor Name: | MR. LESTER PHIL NYBORG |
| NPI Number: | 1740584366 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | M-3478 |
| Business Practice Address: | 550 W. Fort St. (federal Court House) Boise Meps Boise, ID - 837240101 |
| Business Phone Number: | 2083341450 |
| Business Fax Number: | |
| Mailing Address: | 550 W. Fort St., Boise Meps BOISE |
| State: | ID |
| Postal Code: | 837240101 |
| Phone Number: | 2083341450 |
| Fax Number: | |
| NPI Enumeration Date: | 12/23/2010 |
| NPI Last Update Date: | 12/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | M-3478 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |