Individual
TED D EPPERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 367-6042
(208) 947-1761
Mailing address
2180 RIBIER DR, MERIDIAN, ID 83642-5130
(208) 846-8222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-8362
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806253300
—
ID
Enumeration date
05/30/2006
Last updated
09/17/2010
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