Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | M7334 | ID |
NPI | 1295769594 |
---|---|
Provider Name | David E Parry |
First Address | Pocatello, ID 83201 |
Second Address | Pocatello, ID 83201-4835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010003882 | BLUE SHIELD OF ID (01) | ID |
040011016 | RR MEDICARE (01) | ID |
804258400 | (05) | ID |
DI361 | BLUE CROSS OF ID (01) | ID |
G52682 | (02) | ID |
M7334 | STATE LICENSE (01) | ID |