Individual
ANN C AGNEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3080 E GENTRY WAY STE 210, MERIDIAN, ID 83642-3013
(208) 947-5390
(208) 947-3465
Mailing address
1070 E OPUS ST, BOISE, ID 83716-5274
(208) 344-4824
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M9138
ID
208M00000X
Hospitalist Physician
M9138
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806964100
—
ID
Enumeration date
06/12/2006
Last updated
07/16/2018
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