Provider Demographics
NPI:1568413052
Name:TESNOHLIDEK, BARBARA J (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:TESNOHLIDEK
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 1:338 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6207
Mailing Address - Country:US
Mailing Address - Phone:208-336-0895
Mailing Address - Fax:208-336-0895
Practice Address - Street 1:338 E BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6207
Practice Address - Country:US
Practice Address - Phone:208-336-0895
Practice Address - Fax:208-336-0895
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18754207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR061833Medicaid
ID001277900Medicaid
OR006640003OtherREGENCE BCBSO
ORR137156Medicare PIN
OR006640003OtherREGENCE BCBSO