Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | M9452 | ID |
NPI | 1356377535 |
---|---|
Provider Name | Dr. Daniel Richard Marsh |
First Address | Boise, ID 83704-8296 |
Second Address | Boise, ID 83704-8296 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 25/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1356377535 | (05) | ID |
H40161 | (02) | ID |