Organization
MATTHEW R SERICATI, M.D. CHARTERED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW R SERICATI MD (PRESIDENT)
(208) 343-1702
Entity
Organization
Contact information
Practice address
425 W BANNOCK ST, BOISE, ID 83702-6035
(208) 343-1702
(208) 342-7042
Mailing address
425 W BANNOCK ST, BOISE, ID 83702-6035
(208) 343-1702
(208) 342-7042
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
M10669
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194871871
INDIVIDUAL NPI
—
Enumeration date
05/13/2011
Last updated
07/19/2019
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