Individual
PHILLIP C AGRUSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3520 E. LOUISE DR, MERIDIAN, ID 83642
(208) 955-0350
(208) 955-0352
Mailing address
3520 E. LOUISE DR, MERIDIAN, ID 83642
(208) 955-0350
(208) 955-0352
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
M7716
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005656
REGENCE BLUE SHIELD OF ID
ID
05
—
212843
—
OR
05
—
805522900
—
ID
01
—
J1742
BLUE CROSS OF IDAHO
ID
Enumeration date
01/25/2006
Last updated
01/15/2013
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