Individual
KIMBERLY R TANABE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3101 E STATE ST, SUITE 2120, EAGLE, ID 83616-6232
(208) 473-3275
(208) 473-3276
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 706-8000
(208) 706-8001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M5831
ID
Other
Enumeration date
05/05/2006
Last updated
08/21/2012
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