# DEER POINT FAMILY PRACTICE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134342264
- **Authorized official:** GARY A TUBBS M.D. (OWNER)
- **Authorized official phone:** (208) 322-7284

## Contact information

- **Practice address:** 6023 N EAGLE RD, BOISE, ID 83713-0997
- **Practice address phone:** (208) 322-7284
- **Practice address fax:** (208) 323-9070
- **Mailing address:** PO BOX 4979, BOISE, ID 83711-4979
- **Mailing address phone:** (208) 322-7284
- **Mailing address fax:** (208) 323-9070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/10/2007
- **Last updated:** 12/21/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010028455 | REGENCE BLUE SHIELD OF ID | ID |
| 05 | — | 002643400 | — | ID |