Provider Demographics
NPI:1295769594
Name:PARRY, DAVID E (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:PARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S 11TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-233-0801
Mailing Address - Fax:208-233-0803
Practice Address - Street 1:500 S 11TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4835
Practice Address - Country:US
Practice Address - Phone:208-233-0801
Practice Address - Fax:208-233-0803
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7334207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM7334OtherSTATE LICENSE
ID804258400Medicaid
ID040011016OtherRR MEDICARE
IDDI361OtherBLUE CROSS OF ID
ID000010003882OtherBLUE SHIELD OF ID
IDDI361OtherBLUE CROSS OF ID
ID1137446Medicare ID - Type Unspecified