Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | M9267 | ID |
N | 111NI0900X | Internist | M9267 | ID |
Y | 207RI0200X | Infectious Disease | M-9267 | ID |
NPI | 1023026457 |
---|---|
Provider Name | David B Souvenir |
First Address | Lewiston, ID 83501-2431 |
Second Address | Lewiston, ID 83501-2431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 15/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
807175200 | (05) | ID |
G40521 | (02) |