Basic Information
| Provider Information | |||||||||
| NPI: | 1306873435 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGUFFEY | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 N WARDWELL AVE | ||||||||
| Address2: | |||||||||
| City: | EMMETT | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836173040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083656311 | ||||||||
| FaxNumber: | 2083651003 | ||||||||
| Practice Location | |||||||||
| Address1: | 426 HIGHWAY 16 | ||||||||
| Address2: | |||||||||
| City: | EMMETT | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836179461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083652735 | ||||||||
| FaxNumber: | 2083652737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | M9309 | ID | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.