Individual
STUART MIYASAKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-5015
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M-16643
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2019
Last updated
06/15/2022
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