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General NPI Number Information
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NPI Number | 1174108674
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Entity Type | Organization
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Legal Business Name | BOISE ENT, LLC
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 8854 W EMERALD ST STE 150
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City | BOISE
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State | ID
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Zip | 83704-4844
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Country | US
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Telephone | 208-229-2368
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Fax |
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Provider Business Mailing Address
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Address Line | 8854 W EMERALD ST STE 150
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City | BOISE
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State | ID
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Zip | 83704-4844
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Country | US
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Telephone | 208-229-2368
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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. DONALD J BEASLEY
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Credential | MD
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Telephone | 208-229-2368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State |
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