Healthcare Provider Details

I. General information

NPI: 1124055355
Provider Name (Legal Business Name): KARA C TAGGART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARA LOUISE CRISMOND MD

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N 2ND ST SUITE 103
BOISE ID
83702-6077
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-4700
  • Fax: 208-381-4977
Mailing address:
  • Phone: 208-706-5800
  • Fax: 208-706-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberM10408
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: