Provider Demographics
NPI:1063566735
Name:IDDINS, DONALD TERRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:TERRENCE
Last Name:IDDINS
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 1:1500 HIGHWAY 2
Mailing Address - Street 2:SUITE 336
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864
Mailing Address - Country:US
Mailing Address - Phone:208-255-2456
Mailing Address - Fax:208-265-8909
Practice Address - Street 1:1500 HWY 2
Practice Address - Street 2:SUITE 336
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864
Practice Address - Country:US
Practice Address - Phone:208-255-2456
Practice Address - Fax:208-265-8909
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM55992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E51432Medicare UPIN
1124146Medicare ID - Type Unspecified