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NPI Code Detail

MEDICARE: MARTIN R TUBACH MD

MEDICARE: MARTIN R TUBACH 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
1207Y00000XOtolaryngology PhysicianM8065ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982656591
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTIN R TUBACH MD
Provider Business Mailing Address
First Line : 6052 W STATE ST
Second Line :
City : BOISE
State : ID
Zip : 83703-2739
Country : US
Telephone Number : 208-947-1947
Fax Number : 208-947-1945
Provider Business Practice Location Address
First Line : 6052 W STATE ST
Second Line :
City : BOISE
State : ID
Zip : 83703-2739
Country : US
Telephone Number : 208-947-1947
Fax Number : 208-947-1945
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 01/28/2010

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Directions to “ MARTIN R TUBACH MD” Practice Location

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