Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | R1553 | KY |
N | 111NI0900X | Internist | R1553 | KY |
N | 207RC0200X | Critical Care Medicine | 01074336A | IN |
N | 207RP1001X | Pulmonary Disease | 01074336A | IN |
Y | 207RP1001X | Pulmonary Disease | M-15256 | ID |
NPI | 1053575860 |
---|---|
Provider Name | Dr. Zahra Iskra Mathura |
First Address | Meridian, ID 83642 |
Second Address | Boise, ID 83706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 29/12/2020 |