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General NPI Number Information
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NPI Number | 1801216940
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Entity Type | Individual
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Provider Name | SETH BRANAHL M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 520 S EAGLE RD STE 2209
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City | MERIDIAN
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State | ID
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Zip | 83642-6354
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Country | US
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Telephone | 208-706-6400
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Fax | 208-706-6402
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Provider Business Mailing Address
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Address Line | 100 E IDAHO ST STE 401
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City | BOISE
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State | ID
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Zip | 83712-6267
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Country | US
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Telephone | 208-514-6534
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | M-13850
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License Number State | ID
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