Individual
SUSAN LEIGH BLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
701 E PARKCENTER BLVD, BOISE, ID 83706-6528
(208) 381-6400
(208) 381-6450
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M4556
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002251800
—
ID
Enumeration date
05/05/2006
Last updated
01/07/2011
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