Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | M11330 | ID |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | M-11330 | ID |
NPI | 1023144300 |
---|---|
Provider Name | Marcos Daccarett |
First Address | Boise, ID 83712 |
Second Address | Boise, ID 83712-6246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 28/04/2017 |