Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | M-7823 | ID |
NPI | 1215948104 |
---|---|
Provider Name | Colin E Poole |
First Address | Boise, ID 83712-6241 |
Second Address | Boise, ID 83702-4566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 13/09/2012 |