# IDAHO NEUROLOGICAL SURGERY, P.A.

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

## Provider details

- **NPI number:** 1962691204
- **Authorized official:** DR. DOUGLAS E. SMITH M. D. (PRESIDENT/OWNER/NEUROSURGEON)
- **Authorized official phone:** (208) 344-1000

## Contact information

- **Practice address:** 222 N. 2ND STREET, SUITE 307, BOISE, ID 83702-6131
- **Practice address phone:** (208) 344-1000
- **Practice address fax:** (208) 344-1331
- **Mailing address:** 222 N. 2ND STREET, SUITE 307, BOISE, ID 83702-6131
- **Mailing address phone:** (208) 344-1000
- **Mailing address fax:** (208) 344-1331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | M-3522 | ID | Yes |

## Other

- **Enumeration date:** 10/23/2007
- **Last updated:** 10/23/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 002755500 | — | ID |