Provider Demographics
NPI:1124055355
Name:TAGGART, KARA C (MD)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:C
Last Name:TAGGART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:LOUISE
Other - Last Name:CRISMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-706-5800
Mailing Address - Fax:208-706-5810
Practice Address - Street 1:510 N 2ND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6077
Practice Address - Country:US
Practice Address - Phone:208-381-4700
Practice Address - Fax:208-381-4977
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM10408208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20000560Medicare PIN