Individual
SANDY LEIGH MUDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MPH
Contact information
Practice address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 375-2217
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 375-2217
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-12212
ID
207Q00000X
Family Medicine Physician
MRM-1258
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366704017
—
ID
Enumeration date
06/08/2012
Last updated
09/25/2015
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