Provider Demographics
NPI:1134225956
Name:SAUNDERS, MARGO (MD)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:
Last Name:SAUNDERS
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 1:1308 8TH ST
Mailing Address - Street 2:STE 1
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-1535
Mailing Address - Country:US
Mailing Address - Phone:208-436-4322
Mailing Address - Fax:208-436-1312
Practice Address - Street 1:1308 8TH ST STE 1
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350
Practice Address - Country:US
Practice Address - Phone:208-436-4322
Practice Address - Fax:208-436-1312
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6030174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID74146OtherBLUE CROSS
IDM8073867Medicaid
IDM0027582Medicaid
IDM0027582Medicaid
ID1126532Medicare PIN
IDF37134Medicare UPIN