Healthcare Provider Details

I. General information

NPI: 1962875724
Provider Name (Legal Business Name): TODD ALLEN SALZSIEDER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7941 W RIFLEMAN ST
BOISE ID
83704
US

IV. Provider business mailing address

1650 S TOPAZ WAY
MERIDIAN ID
83642-4474
US

V. Phone/Fax

Practice location:
  • Phone: 208-895-7950
  • Fax: 855-212-5682
Mailing address:
  • Phone: 208-605-7070
  • Fax: 208-898-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1335
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: