Provider Demographics
NPI:1871685321
Name:LLOYD E. WITHAM MD PA
Entity type:Organization
Organization Name:LLOYD E. WITHAM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:E
Authorized Official - Last Name:WITHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-667-7459
Mailing Address - Street 1:1107 W IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2604
Mailing Address - Country:US
Mailing Address - Phone:208-667-7459
Mailing Address - Fax:208-667-2631
Practice Address - Street 1:1107 W IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2604
Practice Address - Country:US
Practice Address - Phone:208-667-7459
Practice Address - Fax:208-667-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5216174400000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1119810Medicare ID - Type UnspecifiedMEDICARE
ID0262630001Medicare NSC
IDB63942Medicare UPIN