Individual
JOHN MICHAEL MCNULTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
229 S 8TH ST, ST MARIES FAMILY MEDICINE, ST MARIES, ID 83861-1813
(208) 245-2591
(208) 245-5246
Mailing address
229 S 8TH ST, ST MARIES FAMILY MEDICINE, ST MARIES, ID 83861-1813
(208) 245-2591
(208) 245-5246
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M7646
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010000790
REGENCE BS OF ID
ID
05
—
1043207418
—
MT
01
—
124834
DEPT OF LABOR & INDUSTRIE
WA
01
—
27805
BLUE CROSS OF ID
ID
05
—
8343854
—
WA
Enumeration date
09/30/2005
Last updated
03/04/2008
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