Provider Demographics
NPI:1467618223
Name:SQUYER, EMILY ROSE ANN (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE ANN
Last Name:SQUYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-3900
Mailing Address - Fax:208-302-3905
Practice Address - Street 1:901 N CURTIS ROAD
Practice Address - Street 2:STE 501
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-302-3900
Practice Address - Fax:208-302-3905
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49236174400000X, 207X00000X, 207XX0801X
IDM-13282207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ922304Medicaid
AZZ168291Medicare PIN