Individual
ANN PENDLETON BEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 322-7018
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 514-2500
(208) 322-7018
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M7794
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102990
CIGNA MEDICARE
—
01
—
11029901
MEDICARE PTAN
ID
01
—
1102998
CIGNA MEDICARE
—
05
—
805202000
—
ID
01
—
P00031256
RAILROAD MEDICARE
—
Enumeration date
03/30/2006
Last updated
02/01/2011
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