Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | M-7118 | ID |
N | 208000000X | Pediatrician | M-7118 | ID |
NPI | 1609865880 |
---|---|
Provider Name | Charles Nephi Webb |
First Address | Boise, ID 83706-1347 |
Second Address | Boise, ID 83706-1347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 18/05/2016 |