Healthcare Provider Details

I. General information

NPI: 1043401920
Provider Name (Legal Business Name): SANDPOINT PEDIATRICS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6833 EL PASO
BONNERS FERRY ID
83805-8569
US

IV. Provider business mailing address

420 N 2ND AVE 100
SANDPOINT ID
83864-1552
US

V. Phone/Fax

Practice location:
  • Phone: 208-267-3773
  • Fax: 208-267-1923
Mailing address:
  • Phone: 208-265-2242
  • Fax: 208-265-8214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM4954
License Number StateID

VIII. Authorized Official

Name: JOYCE GILBERT
Title or Position: CO OWNER
Credential: MD
Phone: 208-265-2272