Provider Demographics
NPI:1063548279
Name:SAVALA, EDWARD ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALLEN
Last Name:SAVALA
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 1:301 CLEVELAND BLVD
Mailing Address - Street 2:STE. 110
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-3625
Mailing Address - Country:US
Mailing Address - Phone:208-459-3630
Mailing Address - Fax:208-459-3651
Practice Address - Street 1:524 CLEVELAND BLVD
Practice Address - Street 2:STE. 110
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4076
Practice Address - Country:US
Practice Address - Phone:208-459-3630
Practice Address - Fax:208-459-3651
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8226261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806083300OtherHEALTHY CONNECTION PRV. #
ID806003800Medicaid