Organization
OASIS PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARRIE HUMPHREY MD (PRINCIPAL OFFICER)
(208) 602-2863
Entity
Organization
Contact information
Practice address
3217 W BAVARIA ST, EAGLE, ID 83616-5171
(208) 602-2863
(208) 947-3419
Mailing address
3217 W BAVARIA ST, EAGLE, ID 83616-5171
(208) 602-2863
(208) 947-3419
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M9582
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80673100
—
ID
Enumeration date
08/25/2011
Last updated
08/25/2011
Update your record
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