Provider Demographics
NPI:1629138656
Name:DOC-SIDE MEDICAL GROUP PC
Entity Type:Organization
Organization Name:DOC-SIDE MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-263-3111
Mailing Address - Street 1:502 N 2ND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1558
Mailing Address - Country:US
Mailing Address - Phone:208-263-3111
Mailing Address - Fax:208-265-0427
Practice Address - Street 1:502 N 2ND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1558
Practice Address - Country:US
Practice Address - Phone:208-263-3111
Practice Address - Fax:208-265-0427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-3276207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty