Individual
DR. ETHAN ALEXANDER TAUB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
999 N CURTIS RD STE 415, BOISE, ID 83706-1334
(208) 302-2600
(208) 302-2625
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
P5741
TX
208600000X
Surgery Physician
036137282
IL
208600000X
Surgery Physician
Primary
4061377
ID
208600000X
Surgery Physician
P5741
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320190706
—
TX
Enumeration date
11/19/2011
Last updated
08/13/2024
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