Provider Demographics
NPI:1194832832
Name:AMIEL, TERRY N (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:N
Last Name:AMIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3456 E 17TH ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6757
Mailing Address - Country:US
Mailing Address - Phone:208-529-2828
Mailing Address - Fax:208-529-3890
Practice Address - Street 1:3456 E 17TH ST
Practice Address - Street 2:SUITE 125
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6757
Practice Address - Country:US
Practice Address - Phone:208-529-2828
Practice Address - Fax:208-529-3890
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM6533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDG01748Medicare UPIN
ID1132495Medicare ID - Type Unspecified