Individual
EARL ANTHONY GAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 E IDAHO STREET, SUITE 303, BOISE, ID 83712-6269
(314) 251-4772
(314) 251-5772
Mailing address
100 E IDAHO STREET, SUITE 303, BOISE, ID 83712-6269
(208) 433-1736
(208) 433-1738
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
2012011130
MO
208200000X
Plastic Surgery Physician
Primary
M-17141
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134302433
—
ID
Enumeration date
12/10/2007
Last updated
06/30/2023
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