Individual
DR. PHILIP BRUCE MEADOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O. F.A.C.R.
Contact information
Practice address
700 W IRONWOOD DR STE 275W, COEUR D ALENE, ID 83814-4400
(208) 625-4780
(208) 625-4781
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-4000
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
043709
GA
207RR0500X
Rheumatology Physician
Primary
O-1470
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000750373C
—
GA
01
—
1437288255
MEDICARE GROUP NPI
GA
01
—
660003950
RAILROAD MEDICARE
GA
01
—
66BBGB
MEDICARE ID
GA
01
—
GRP4761
MEDICARE GROUP PTAN
GA
Enumeration date
08/20/2006
Last updated
02/15/2021
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