Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ID |
NPI | 1114280203 |
---|---|
Provider Name | Dr. Colby Todd Inzer |
First Address | Eagle, ID 83616-1365 |
Second Address | Eagle, ID 83616-4900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2012 |
Last Update Date | 29/07/2013 |