Healthcare Provider Details

I. General information

NPI: 1225011893
Provider Name (Legal Business Name): ERIC T GARNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N LIBERTY ST STE 400
BOISE ID
83704-8704
US

IV. Provider business mailing address

900 N LIBERTY ST STE 400
BOISE ID
83704-8704
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-3320
  • Fax: 208-367-7474
Mailing address:
  • Phone: 208-367-3320
  • Fax: 208-367-7474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberM5636
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: