Basic Information
Provider Information
NPI: 1265570360
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NOWBAR
FirstName: SOGOL
MiddleName:  
NamePrefix: DR.
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: 837126241
CountryCode: US
TelephoneNumber: 2083230031
FaxNumber: 2083230064
Practice Location
Address1: 2347 E GALA ST
Address2:  
City: MERIDIAN
State: ID
PostalCode: 836424881
CountryCode: US
TelephoneNumber: 2083230031
FaxNumber: 2083230064
Other Information
ProviderEnumerationDate: 02/01/2007
LastUpdateDate: 08/19/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001XM-8842IDY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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