Healthcare Provider Details

I. General information

NPI: 1801882881
Provider Name (Legal Business Name): MARY ELIZABETH BARINAGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 B STREET
PLUMMER ID
83851
US

IV. Provider business mailing address

21651 S LAKEVIEW DR
WORLEY ID
83876-7615
US

V. Phone/Fax

Practice location:
  • Phone: 208-686-1931
  • Fax: 208-686-0242
Mailing address:
  • Phone: 208-667-1204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM7054
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00036315
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: