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NPI Code Detail

MEDICARE: LISA L DOCKTER MD

MEDICARE: LISA L DOCKTER MD
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
1207Q00000XFamily Medicine PhysicianM8516ID

General Provider Information

NPI Number : 1285689034
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA L DOCKTER MD
Provider Business Mailing Address
First Line : PO BOX 9
Second Line :
City : NAMPA
State : ID
Zip : 83653-0009
Country : US
Telephone Number : 208-461-7149
Fax Number : 208-466-5359
Provider Business Practice Location Address
First Line : 300 S 23RD ST
Second Line :
City : BOISE
State : ID
Zip : 83702-9100
Country : US
Telephone Number : 208-344-3512
Fax Number : 208-466-5359
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2006
Last Update Date : 08/26/2024

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Directions to “ LISA L DOCKTER MD” Practice Location

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