Basic Information
Provider Information
NPI: 1811942543
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WRITER
FirstName: STEVEN
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3340 E GOLDSTONE WAY
Address2:  
City: MERIDIAN
State: ID
PostalCode: 83642
CountryCode: US
TelephoneNumber: 2083020000
FaxNumber: 2083020055
Practice Location
Address1: 6140 W CURTISIAN
Address2: STE 200
City: BOISE
State: ID
PostalCode: 83704
CountryCode: US
TelephoneNumber: 2083020000
FaxNumber: 2083020055
Other Information
ProviderEnumerationDate: 05/23/2006
LastUpdateDate: 11/15/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0011XM4823IDY Allopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology

No ID Information.


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