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Organization
BOISE OBSTETRIC & GYNECOLOGIC ASSOCIATES PA
Active
Organization
BOISE OBSTETRIC & GYNECOLOGIC ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL R GLEASON (CLINIC ADMINISTRATOR)
(208) 375-8100
Entity
Organization
Contact information
Practice address
5966 CURTISIAN AVE, BOISE, ID 83704
(208) 375-8100
(208) 373-2643
Mailing address
5966 CURTISIAN AVE, BOISE, ID 83704
(208) 375-8100
(208) 373-2643
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290426
BLUE SHIELD
ID
01
—
29381
BLUE SHIELD
ID
05
—
808037700
—
ID
01
—
89300
BLUE CROSS
ID
01
—
8E936
BLUE CROSS
ID
Enumeration date
06/06/2006
Last updated
06/16/2008
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