Healthcare Provider Details

I. General information

NPI: 1669303137
Provider Name (Legal Business Name): MD MEDICAL MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N 3RD STREET BOX 952
PARMA ID
83660
US

IV. Provider business mailing address

108 N 3RD STREET BOX 952
PARMA ID
83660
US

V. Phone/Fax

Practice location:
  • Phone: 208-466-2967
  • Fax:
Mailing address:
  • Phone: 208-466-2967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DARREN FISHER
Title or Position: COO
Credential:
Phone: 949-510-3118