Provider Demographics
NPI:1396788303
Name:TALFORD, DAVID B (PAC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:B
Last Name:TALFORD
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E WARM SPRINGS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6243
Mailing Address - Country:US
Mailing Address - Phone:208-343-5910
Mailing Address - Fax:208-384-8562
Practice Address - Street 1:100 E WARM SPRINGS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6243
Practice Address - Country:US
Practice Address - Phone:208-343-5910
Practice Address - Fax:208-384-8562
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-262363A00000X, 363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805455600Medicaid
ID1666197Medicare ID - Type UnspecifiedMEDICARE
S80558Medicare UPIN