Healthcare Provider Details

I. General information

NPI: 1023228558
Provider Name (Legal Business Name): BOISE GASTROENTEROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6259 W EMERALD ST
BOISE ID
83704-8731
US

IV. Provider business mailing address

6259 W EMERALD ST
BOISE ID
83704-8731
US

V. Phone/Fax

Practice location:
  • Phone: 208-489-1900
  • Fax: 208-375-5286
Mailing address:
  • Phone: 208-489-1900
  • Fax: 208-375-5286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT F GIBSON
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 208-489-1900