Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | M10479 | ID |
NPI | 1013984517 |
---|---|
Provider Name | Dr. Frederick K Emge |
First Address | Eagle, ID 83616-2944 |
Second Address | Boise, ID 83712-6267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 30/08/2011 |