Basic Information
| Provider Information | |||||||||
| NPI: | 1396791513 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TWEETEN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 N CURTIS RD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837061336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083731200 | ||||||||
| FaxNumber: | 2083731216 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 N CURTIS RD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837061336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083731200 | ||||||||
| FaxNumber: | 2083731216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | M-5559 | ID | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 000010005787 | 01 | ID | REGENCE BLUE SHIELD | OTHER | DA145 | 01 | ID | BLUE CROSS | OTHER |