Provider Demographics
NPI:1477866606
Name:IDAHO ALLERGY L.L.C.
Entity Type:Organization
Organization Name:IDAHO ALLERGY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:FRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-938-3443
Mailing Address - Street 1:379 E SHORE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5410
Mailing Address - Country:US
Mailing Address - Phone:208-938-3443
Mailing Address - Fax:208-938-3553
Practice Address - Street 1:379 E SHORE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5410
Practice Address - Country:US
Practice Address - Phone:208-938-3443
Practice Address - Fax:208-938-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM103207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty