Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | M-7105 | ID |
NPI | 1104878446 |
---|---|
Provider Name | Philippe A. Masser |
First Address | Boise, ID 83712-6241 |
Second Address | Boise, ID 83702-6100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 10/09/2012 |