MEDICARE: ALAN J A PITT MD P A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	M7850	ID

General Provider Information

NPI Number	:	1154489821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAN J A PITT MD P A

Provider Business Mailing Address
First Line	:	1919 N 21ST ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-0736
Country	:	US
Telephone Number	:	208-331-3513
Fax Number	:

Provider Business Practice Location Address
First Line	:	1618 MILLENIUM WAY
Second Line	:	#100
City	:	MERIDIAN
State	:	ID
Zip	:	83642-6439
Country	:	US
Telephone Number	:	208-884-3376
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALAN J PITT
Credential	:	MD
Telephone Number	:	208-331-3513

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/01/2010

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