Organization
ST JOSEPHS EAR NOSE AND THROAT CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS R DETAR M.D., F.A.C.S. (OWNER/MEMBER)
(208) 777-1320
Entity
Organization
Contact information
Practice address
849 N SYRINGA ST, POST FALLS, ID 83854-8794
(208) 777-1320
(208) 777-1322
Mailing address
849 N SYRINGA ST, POST FALLS, ID 83854-8794
(208) 777-1320
(208) 777-1322
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000100006619
REGENCE/ASURIS
ID
01
—
151513
WASHINGTON L&I
ID
05
—
7087273
—
ID
05
—
805084300
—
ID
01
—
8938054
WA L&I CRIME VICTIMS
ID
01
—
8M012
BLUE CROSS OF IDAHO
ID
Enumeration date
05/19/2006
Last updated
02/06/2024
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