Individual
DAVID E FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2347 E GALA ST, MERIDIAN, ID 83642-4881
(208) 323-3767
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
54310-20
WI
207RP1001X
Pulmonary Disease Physician
54310-20
WI
207RP1001X
Pulmonary Disease Physician
Primary
M11826
ID
Other
Enumeration date
07/11/2007
Last updated
04/26/2013
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