Provider Demographics
NPI:1245210228
Name:CYPRUS, IDALYN (MD)
Entity type:Individual
Prefix:DR
First Name:IDALYN
Middle Name:
Last Name:CYPRUS
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 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-947-7700
Mailing Address - Fax:208-947-7701
Practice Address - Street 1:1520 W STATE ST
Practice Address - Street 2:STE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4038
Practice Address - Country:US
Practice Address - Phone:208-947-7700
Practice Address - Fax:208-947-7701
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine