Provider Demographics
NPI:1912933144
Name:ORCHARD, DOUGLAS H (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:H
Last Name:ORCHARD
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 1:10787 USTICK RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5104
Mailing Address - Country:US
Mailing Address - Phone:208-378-8011
Mailing Address - Fax:208-378-8095
Practice Address - Street 1:10787 WEST USTICK
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713
Practice Address - Country:US
Practice Address - Phone:208-378-8011
Practice Address - Fax:208-378-8095
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B63455Medicare UPIN
ID1130622Medicare ID - Type Unspecified