Individual
JANICE BOUGHTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
700 S MAIN ST, MOSCOW, ID 83843-3056
(509) 334-8567
(208) 883-6551
Mailing address
700 S MAIN ST, MOSCOW, ID 83843-3056
(509) 334-8567
(208) 883-6551
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M-6527
ID
207R00000X
Internal Medicine Physician
MD00025772
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002641100
—
ID
05
—
8116196
—
WA
Enumeration date
07/02/2006
Last updated
04/30/2020
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