Individual
DR. CLAINE DOYLE JUDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
755 HOSPITAL WAY, STE A-5, POCATELLO, ID 83201-2717
(208) 233-8444
(208) 233-6920
Mailing address
755 HOSPITAL WAY, POCATELLO, ID 83201-2795
(208) 233-8444
(208) 233-6920
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
O-279
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010138779
REGENCE BLUE SHIELD OF ID
ID
01
—
S3895
BLUE CROSS OF IDAHO
ID
05
—
XPY200851
—
CA
Enumeration date
09/14/2005
Last updated
08/22/2007
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