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Individual

ANDREW THAYNE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1951 BENCH RD, SUITE B, POCATELLO, ID 83201-2073
(208) 238-1000
(208) 238-0009
Mailing address
1951 BENCH RD, SUITE B, POCATELLO, ID 83201-2073
(208) 238-1000
(208) 238-0009

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M9047
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
806857400
ID
01
P00108846
RAILROAD MEDICARE PTAN
ID
Enumeration date
07/09/2006
Last updated
09/22/2011
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