Individual
THOMAS M RAMBOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
8950 W EMERALD STE 168, BOISE, ID 83704
(208) 323-6273
(208) 323-6277
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
(208) 323-6277
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA260
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010017781
BLUE SHIELD
ID
05
—
805478400
—
ID
01
—
PA381
BLUE CROSS
ID
Enumeration date
04/01/2006
Last updated
06/11/2013
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