Healthcare Provider Details

I. General information

NPI: 1780970491
Provider Name (Legal Business Name): ABBY DAVIDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 W EMERALD ST
BOISE ID
83704-8737
US

IV. Provider business mailing address

777 N RAYMOND ST
BOISE ID
83704-9251
US

V. Phone/Fax

Practice location:
  • Phone: 208-514-2510
  • Fax: 208-375-2217
Mailing address:
  • Phone: 208-514-2500
  • Fax: 208-375-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number248510
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-12366
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: