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NPI Code Detail

MEDICARE: DR. ERIC B MAUGHAN MD

MEDICARE: DR. ERIC B MAUGHAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianM8776ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
158214OTHERIDBLUE CROSS

General Provider Information

NPI Number : 1871579193
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIC B MAUGHAN MD
Provider Business Mailing Address
First Line : PO BOX 1647
Second Line : 2860 CHANNING WAY SUITE 115
City : IDAHO FALLS
State : ID
Zip : 83403-1647
Country : US
Telephone Number : 208-535-4130
Fax Number : 508-535-4125
Provider Business Practice Location Address
First Line : 3100 CHANNING WAY
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83404-7533
Country : US
Telephone Number : 208-535-4130
Fax Number : 208-535-4125
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2005
Last Update Date : 07/08/2007

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Directions to “ DR. ERIC B MAUGHAN MD” Practice Location

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