Provider Demographics
NPI:1154489821
Name:ALAN J A PITT MD P A
Entity Type:Organization
Organization Name:ALAN J A PITT MD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-331-3513
Mailing Address - Street 1:1919 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0736
Mailing Address - Country:US
Mailing Address - Phone:208-331-3513
Mailing Address - Fax:
Practice Address - Street 1:1618 MILLENIUM WAY
Practice Address - Street 2:#100
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6439
Practice Address - Country:US
Practice Address - Phone:208-884-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7850207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1141946Medicare ID - Type Unspecified