Healthcare Provider Details

I. General information

NPI: 1700725918
Provider Name (Legal Business Name): WINSTON LIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST # 111R
BOISE ID
83702-4501
US

IV. Provider business mailing address

500 W FORT ST # 111R
BOISE ID
83702-4501
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1000
  • Fax:
Mailing address:
  • Phone: 208-422-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1700725918
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: