Healthcare Provider Details

I. General information

NPI: 1588982656
Provider Name (Legal Business Name): SARAH MARIA DACCARETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH MARIA CLIFFORD M.D.

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 E PARK BLVD STE 200
BOISE ID
83712-7782
US

IV. Provider business mailing address

827 E PARK BLVD STE 200
BOISE ID
83712-7782
US

V. Phone/Fax

Practice location:
  • Phone: 208-781-0412
  • Fax:
Mailing address:
  • Phone: 208-781-0412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number7633610-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License NumberMD161763
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License NumberM-12016
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: