Provider Demographics
NPI:1760682066
Name:SONNTAG, PAUL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:SONNTAG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:115 W MAIN ST
Mailing Address - Street 2:#202
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702
Mailing Address - Country:US
Mailing Address - Phone:208-433-9466
Mailing Address - Fax:208-433-1149
Practice Address - Street 1:190 E BANNOCK
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712
Practice Address - Country:US
Practice Address - Phone:208-381-2094
Practice Address - Fax:208-381-1791
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2015-07-07
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Provider Licenses
StateLicense IDTaxonomies
IDM119502085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology