Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | M-14963 | ID |
NPI | 1003267493 |
---|---|
Provider Name | Lauren Brogis |
First Address | Moscow, ID 83843-3046 |
Second Address | Moscow, ID 83843-3046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2016 |
Last Update Date | 24/02/2020 |