Provider Demographics
NPI:1164597431
Name:CIPRIANO, DOUGLAS ALAN (MD)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:CIPRIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:606 N. 3RD AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1689
Mailing Address - Country:US
Mailing Address - Phone:208-263-8597
Mailing Address - Fax:208-265-0667
Practice Address - Street 1:606 N. 3RD AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1689
Practice Address - Country:US
Practice Address - Phone:208-263-8597
Practice Address - Fax:208-265-0667
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6568207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8464828Medicaid
IDP00041410OtherRAILROAD MEDICARE
ID360191400OtherUS DEPT OF LABOR
MT1164597431Medicaid
ID76559OtherBLUE CROSS
ID000010000103OtherREGENCE BLUE SHIELD
ID002777500Medicaid
ID1009215OtherIDAHO STATE INSURANCE
IDP00041410OtherRAILROAD MEDICARE
MT1164597431Medicaid