Provider Demographics
NPI:1942216981
Name:STRAND, MARILYN (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:STRAND
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 1:6635 COMANCHE ST
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-7523
Mailing Address - Country:US
Mailing Address - Phone:208-267-1718
Mailing Address - Fax:208-267-7739
Practice Address - Street 1:6635 COMANCHE ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-7523
Practice Address - Country:US
Practice Address - Phone:208-267-1718
Practice Address - Fax:208-267-7739
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010142695OtherREGENCE OF IDAHO GROUP
ID000010160939OtherREGENCE OF IDAHO
ID000010160939OtherREGENCE OF IDAHO
ID131832Medicare ID - Type UnspecifiedFQHC SANDPOINT
ID1104558Medicare ID - Type Unspecified
ID131822Medicare ID - Type UnspecifiedFQHC BONNERS FERRY