Basic Information
Provider Information
NPI: 1255386942
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FIELD
FirstName: JAMES
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 190 E BANNOCK ST
Address2:  
City: BOISE
State: ID
PostalCode: 83712
CountryCode: US
TelephoneNumber: 2084546363
FaxNumber: 2084543512
Practice Location
Address1: 315 E ELM ST
Address2: STE 350
City: CALDWELL
State: ID
PostalCode: 83605
CountryCode: US
TelephoneNumber: 2084546363
FaxNumber: 2084543512
Other Information
ProviderEnumerationDate: 05/23/2006
LastUpdateDate: 11/16/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XM7474IDY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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