Basic Information
| Provider Information | |||||||||
| NPI: | 1720173628 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IDAHO SLEEP SPECIALISTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 S 11TH ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837026969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088950411 | ||||||||
| FaxNumber: | 2088950406 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 S 11TH ST | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837026969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088950411 | ||||||||
| FaxNumber: | 2088950406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 10/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | TROYER | ||||||||
| AuthorizedOfficialFirstName: | BRETT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2088950411 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
No ID Information.