Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | M6109 | ID |
NPI | 1679512982 |
---|---|
Provider Name | Dr. Thomas H. Rand |
First Address | Boise, ID 83712-6241 |
Second Address | Boise, ID 83712-6267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 15/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003904800 | (05) | ID |
E85581 | (02) |