Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | M5636 | ID |
NPI | 1225011893 |
---|---|
Provider Name | Dr. Eric T Garner |
First Address | Boise, ID 83704-8704 |
Second Address | Boise, ID 83704-8704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 01/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002731400 | (05) | ID |
D49623 | (02) | ID |