Individual
SHANA L TUBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1072 N LIBERTY ST, SUITE 203, BOISE, ID 83704-8708
(208) 302-5800
(208) 302-5855
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-5800
(208) 302-5855
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M-8077
ID
208000000X
Pediatrics Physician
M8077
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805784500
—
ID
Enumeration date
06/14/2006
Last updated
11/10/2016
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