Provider Demographics
NPI:1023008414
Name:DOUTHIT, THOMAS F (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:DOUTHIT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N. LIBERTY ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8707
Mailing Address - Country:US
Mailing Address - Phone:208-367-3320
Mailing Address - Fax:208-367-7474
Practice Address - Street 1:900 N. LIBERTY ST.
Practice Address - Street 2:SUITE 400
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8707
Practice Address - Country:US
Practice Address - Phone:208-367-3320
Practice Address - Fax:208-367-7474
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q05799Medicare UPIN