Individual
DR. THOMAS R DETAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.C.S.
Contact information
Practice address
849 N SYRINGA ST, POST FALLS, ID 83854-8794
(208) 777-1320
(208) 777-1322
Mailing address
849 N SYRINGA ST, POST FALLS, ID 83854-8794
(208) 777-1320
(208) 777-1322
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
M-7110
ID
207Y00000X
Otolaryngology Physician
Primary
M-7110
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002802400
—
ID
Enumeration date
06/20/2005
Last updated
02/06/2024
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