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Individual

JOHN R SONNTAG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5680 W GAGE ST, BOISE, ID 83706-1326
(208) 377-3937
(208) 377-9455
Mailing address
5680 W GAGE ST, BOISE, ID 83706-1326
(280) 377-3937
(208) 377-9455

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M4623
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001553800
ID
Enumeration date
08/29/2005
Last updated
06/25/2012
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