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General NPI Number Information
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NPI Number | 1417937517
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Entity Type | Individual
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Provider Name | VAUN J ARCHIBALD DO
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Gender | Male
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 06/04/2013
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Provider Practice Location Address
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Address Line | 1072 N LIBERTY ST SUITE 203
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City | BOISE
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State | ID
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Zip | 83704-8708
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Country | US
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Telephone | 208-367-4321
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Fax | 208-367-4525
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Provider Business Mailing Address
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Address Line | 3340 E GOLDSTONE WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-1026
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Country | US
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Telephone | 208-367-5170
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Fax | 208-367-5180
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | O-0449
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | O-0449
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License Number State | ID
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