Healthcare Provider Details

I. General information

NPI: 1861339509
Provider Name (Legal Business Name): CODY E TARBOX PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E HAWAII AVE STE 140
NAMPA ID
83686-6011
US

IV. Provider business mailing address

777 N RAYMOND ST
BOISE ID
83704-9251
US

V. Phone/Fax

Practice location:
  • Phone: 208-514-2529
  • Fax: 208-375-2217
Mailing address:
  • Phone: 208-514-2500
  • Fax: 208-375-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2671495
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: