Healthcare Provider Details

I. General information

NPI: 1336242445
Provider Name (Legal Business Name): ERIC DEUTSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 E. BANNOCK
BOISE ID
83712-6207
US

IV. Provider business mailing address

338 E. BANNOCK
BOISE ID
83712
US

V. Phone/Fax

Practice location:
  • Phone: 208-336-0895
  • Fax:
Mailing address:
  • Phone: 208-336-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number49967
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT2006018415
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: