Individual
TARA LEIGH WEEKS VIZCARRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
810 SIXTH AVE, SANDPOINT, ID 83864-5396
(208) 265-2242
Mailing address
810 SIXTH AVE, SANDPOINT, ID 83864-5396
(208) 265-2242
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
61965
TN
208000000X
Pediatrics Physician
Primary
M-17662
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/12/2017
Last updated
04/08/2024
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