Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 0110 | ID |
NPI | 1104932839 |
---|---|
Provider Name | Dr. Russell Turner Snow |
First Address | Caldwell, ID 83605 |
Second Address | Caldwell, ID 83605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 02/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002697800 | (05) | ID |
B48465 | (02) |