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General NPI Number Information
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NPI Number | 1831285857
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Entity Type | Organization
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Legal Business Name | BOISE BASIN INFERTILITY & GYNECOLOGY, P.A.
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 811 N 6TH ST
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City | BOISE
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State | ID
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Zip | 83702-5545
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Country | US
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Telephone | 208-345-2006
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Fax | 208-345-1408
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Provider Business Mailing Address
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Address Line | 811 N 6TH ST
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City | BOISE
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State | ID
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Zip | 83702-5545
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Country | US
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Telephone | 208-345-2006
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Fax | 208-345-1408
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILIP M KRUEGER
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Credential |
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Telephone | 208-345-2006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M-3549
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License Number State | ID
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