Healthcare Provider Details

I. General information

NPI: 1720033368
Provider Name (Legal Business Name): FAMILY MEDICINE COEUR D'ALENE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 101
COEUR D ALENE ID
83814-2666
US

IV. Provider business mailing address

700 W IRONWOOD DR STE 101
COEUR D ALENE ID
83814-2666
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-2541
  • Fax: 208-664-1173
Mailing address:
  • Phone: 208-667-2541
  • Fax: 208-664-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT M MCFARLAND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 208-667-2541