Provider Demographics
NPI:1902840317
Name:PICA, DONALD G (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:G
Last Name:PICA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 SHOSHONE ST E
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6110
Mailing Address - Country:US
Mailing Address - Phone:208-732-3236
Mailing Address - Fax:208-732-3112
Practice Address - Street 1:660 SHOSHONE ST E
Practice Address - Street 2:SUITE 210
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6110
Practice Address - Country:US
Practice Address - Phone:208-732-3236
Practice Address - Fax:208-732-3112
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2007-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM3098207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDD73456Medicare UPIN
ID1109078Medicare ID - Type UnspecifiedMEDICARE NUMBER
IDP00035234Medicare PIN