Provider Demographics
NPI:1447475918
Name:EAGLE PEDIATRICS,P.A.
Entity type:Organization
Organization Name:EAGLE PEDIATRICS,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-939-4880
Mailing Address - Street 1:125 N. STIERMAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-0000
Mailing Address - Country:US
Mailing Address - Phone:208-939-4880
Mailing Address - Fax:208-939-5003
Practice Address - Street 1:125 N. STIERMAN
Practice Address - Street 2:SUITE A
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5136
Practice Address - Country:US
Practice Address - Phone:208-939-4880
Practice Address - Fax:208-939-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6036261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care