Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | M3021 | ID |
NPI | 1003861253 |
---|---|
Provider Name | James R Swartley |
First Address | Boise, ID 83702-6109 |
Second Address | Boise, ID 83702-6109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B63332 | (02) |