Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | M9268 | ID |
NPI | 1023085180 |
---|---|
Provider Name | Dr. Christopher J Goulet |
First Address | Boise, ID 83704-8731 |
Second Address | Boise, ID 83704-8731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 07/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I34232 | (02) | ID |