Individual
SHANA D FOGARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-5085
(208) 625-5731
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-5085
(208) 625-5731
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD61238314
WA
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
MD61238314
WA
208M00000X
Hospitalist Physician
Primary
M8664
ID
208M00000X
Hospitalist Physician
MD61238314
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00204201
RAILROAD MEDICARE
ID
Enumeration date
05/17/2006
Last updated
12/22/2021
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