Healthcare Provider Details

I. General information

NPI: 1679512982
Provider Name (Legal Business Name): THOMAS H. RAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E IDAHO ST SUITE 200
BOISE ID
83712-6267
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-7330
  • Fax: 208-381-7331
Mailing address:
  • Phone: 208-381-7330
  • Fax: 208-381-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberM6109
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: