Mack, Gordon K

Mack, Gordon K is an individual health care provider with primary practice located at 100 E Idaho St Suite 304, Boise ID 83712-6267. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Cardiology, which is considered as his primary health care specialty. Mack, Gordon K can be contacted via phone (208) 381-7384.

Contact Information

Primary practice address
100 E Idaho St Suite 304 Boise ID 83712-6267
Phone: (208) 381-7384
Fax: (208) 381-7387
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Cardiology 2080P0202X 7320207-1205 Utah
Allopathic & Osteopathic Physicians / Pediatric Cardiology 2080P0202X M-12151 Idaho

Profile Details

NPI number 1982937058
LBN Legal business name Mack, Gordon K
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 8th, 2009
Last updated Feb 5th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982937058 NPPES
Idaho MEDICAID 1982937058

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