Provider Demographics
NPI:1003137050
Name:WILLIAM R. BOZARTH, M.D., P.S.
Entity Type:Organization
Organization Name:WILLIAM R. BOZARTH, M.D., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RICHTER
Authorized Official - Last Name:BOZARTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-746-3320
Mailing Address - Street 1:338 6TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2419
Mailing Address - Country:US
Mailing Address - Phone:208-746-3320
Mailing Address - Fax:208-746-8717
Practice Address - Street 1:338 6TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2419
Practice Address - Country:US
Practice Address - Phone:208-746-3320
Practice Address - Fax:208-746-8717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM36262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty