Healthcare Provider Details

I. General information

NPI: 1982641882
Provider Name (Legal Business Name): DONALD G PICA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 03/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 SHOSHONE ST E SUITE 210
TWIN FALLS ID
83301-6110
US

IV. Provider business mailing address

660 SHOSHONE ST E SUITE 210
TWIN FALLS ID
83301-6110
US

V. Phone/Fax

Practice location:
  • Phone: 208-732-3236
  • Fax: 208-732-3112
Mailing address:
  • Phone: 208-732-3236
  • Fax: 208-732-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DONALD G PICA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 208-732-3236