Individual
DANIEL BRODIE MCINTOSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
307 SAINT JOHNS WAY, STE #9, LEWISTON, ID 83501-2435
(208) 746-7055
(208) 746-4899
Mailing address
307 SAINT JOHNS WAY, STE #9, LEWISTON, ID 83501-2435
(208) 746-7055
(208) 746-4899
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M5406
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010005765
REGENCE
ID
05
—
000826400
—
ID
01
—
54064
BLUE CROSS OF IDAHO
ID
Enumeration date
06/19/2006
Last updated
07/08/2007
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