Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | M7295 | ID |
NPI | 1043216823 |
---|---|
Provider Name | Dr. Scot B Scheffel |
First Address | Boise, ID 83706-3009 |
Second Address | Boise, ID 83706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 16/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043216823 | (05) | ID |
G62935 | (02) | ID |