Provider Demographics
NPI:1952822942
Name:DELRAY MAUGHAN, M.D. PLLC
Entity Type:Organization
Organization Name:DELRAY MAUGHAN, M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELRAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-938-5823
Mailing Address - Street 1:13900 W WAINWRIGHT DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5028
Mailing Address - Country:US
Mailing Address - Phone:208-938-5823
Mailing Address - Fax:209-938-5306
Practice Address - Street 1:13900 W WAINWRIGHT DR STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5028
Practice Address - Country:US
Practice Address - Phone:208-938-5823
Practice Address - Fax:208-938-5306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-4908207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty