Organization
DEER POINT FAMILY PRACTICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY A TUBBS M.D. (OWNER)
(208) 322-7284
Entity
Organization
Contact information
Practice address
6023 N EAGLE RD, BOISE, ID 83713-0997
(208) 322-7284
(208) 323-9070
Mailing address
PO BOX 4979, BOISE, ID 83711-4979
(208) 322-7284
(208) 323-9070
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010028455
REGENCE BLUE SHIELD OF ID
ID
05
—
002643400
—
ID
Enumeration date
04/10/2007
Last updated
12/21/2011
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