Provider Demographics
NPI:1487773701
Name:DARIN L. WEYHRICH, M.D.,P.A.
Entity type:Organization
Organization Name:DARIN L. WEYHRICH, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WEYHRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-642-2516
Mailing Address - Street 1:222 N 2ND ST STE 206
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6130
Mailing Address - Country:US
Mailing Address - Phone:208-342-2615
Mailing Address - Fax:208-342-1661
Practice Address - Street 1:222 N 2ND ST STE 206
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6130
Practice Address - Country:US
Practice Address - Phone:208-342-2615
Practice Address - Fax:208-342-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8503207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010139603OtherREGENCE BLUE SHIELD GROUP
ID8G023OtherBLUE CROSS IDAHO GROUP
ID13D0521509OtherCLIA LAB CERTIFICATION
ID1374698Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER