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General NPI Number Information
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NPI Number | 1447475918
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Entity Type | Organization
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Legal Business Name | EAGLE PEDIATRICS,P.A.
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 125 N. STIERMAN SUITE A
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City | EAGLE
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State | ID
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Zip | 83616-5136
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Country | US
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Telephone | 208-939-4880
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Fax | 208-939-5003
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Provider Business Mailing Address
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Address Line | 125 N. STIERMAN WAY SUITE A
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City | EAGLE
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State | ID
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Zip | 83616-0000
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Country | US
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Telephone | 208-939-4880
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Fax | 208-939-5003
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALAN P MILLER
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Credential | M.D.
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Telephone | 208-939-4880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | M6036
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License Number State | ID
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