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General NPI Number Information
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NPI Number | 1871685321
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Entity Type | Organization
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Legal Business Name | LLOYD E. WITHAM MD PA
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 1107 W IRONWOOD DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2604
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Country | US
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Telephone | 208-667-7459
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Fax | 208-667-2631
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Provider Business Mailing Address
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Address Line | 1107 W IRONWOOD DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2604
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Country | US
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Telephone | 208-667-7459
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Fax | 208-667-2631
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LLOYD E WITHAM
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Credential | MD
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Telephone | 208-667-7459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | M5216
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M5216
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License Number State | ID
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