Provider Demographics
NPI:1295755403
Name:EBERHARTER RANKIN, GAIL M (MD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:M
Last Name:EBERHARTER RANKIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3858 N GARDEN CENTER WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-5008
Mailing Address - Country:US
Mailing Address - Phone:208-385-7711
Mailing Address - Fax:208-385-0346
Practice Address - Street 1:3858 N GARDEN CENTER WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-5008
Practice Address - Country:US
Practice Address - Phone:208-385-7711
Practice Address - Fax:208-385-0346
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2018-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM46318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002749000Medicaid
ID002749000Medicaid
ID1118207Medicare ID - Type Unspecified