Individual
TARA S WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1520 W STATE ST, SUITE 100, BOISE, ID 83702-4085
(208) 947-7700
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-11855
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134416647
—
ID
Enumeration date
07/05/2011
Last updated
05/05/2021
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