Provider Demographics
NPI:1164644159
Name:PITTARD, DARREN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:SCOTT
Last Name:PITTARD
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 1:3520 E LOUISE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6304
Mailing Address - Country:US
Mailing Address - Phone:208-888-0909
Mailing Address - Fax:208-888-5825
Practice Address - Street 1:3520 E LOUISE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6304
Practice Address - Country:US
Practice Address - Phone:208-888-0909
Practice Address - Fax:208-888-5825
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-11470207V00000X
IN01063699A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology