Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | M-8219 | ID |
N | 207RN0300X | Nephrologist | MD00037068 | WA |
NPI | 1073629150 |
---|---|
Provider Name | Shaun K Joshi |
First Address | Hayden, ID 83835-7412 |
Second Address | Hayden, ID 83835-7412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 16/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11003291 | MEDICARE PTAN (01) | |
1370136 | MEDICARE GROUP PTAN (01) | |
7144785 | (05) | WA |
8058994 | (05) | ID |
8080036 | (05) | ID |
8239220 | (05) | WA |