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General NPI Number Information
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NPI Number | 1154489821
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Entity Type | Organization
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Legal Business Name | ALAN J A PITT MD P A
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 1618 MILLENIUM WAY #100
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City | MERIDIAN
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State | ID
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Zip | 83642-6439
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Country | US
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Telephone | 208-884-3376
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 N 21ST ST
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City | BOISE
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State | ID
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Zip | 83702-0736
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Country | US
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Telephone | 208-331-3513
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALAN J PITT
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Credential | MD
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Telephone | 208-331-3513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | M7850
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License Number State | ID
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