Individual
TAKAHISA KOIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
700 CALDWELL BLVD, NAMPA, ID 83651-1707
(208) 466-6567
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2208
ID
Other
Enumeration date
03/10/2022
Last updated
03/10/2022
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