Provider Demographics
NPI:1306895016
Name:CEGNAR, JANET M (MD)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:M
Last Name:CEGNAR
Suffix:
Gender:F
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:PO BOX 9649
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83707-4649
Mailing Address - Country:US
Mailing Address - Phone:208-472-8100
Mailing Address - Fax:208-472-8172
Practice Address - Street 1:1055 N CURTIS RD
Practice Address - Street 2:GEM STATE RADIOLOGY
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1309
Practice Address - Country:US
Practice Address - Phone:208-367-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD182672085R0202X
IDM-62572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR004837002OtherBLUE CROSS
OR058052Medicaid
ID003639600OtherMEDICAID
OR00WFBWLAMedicare ID - Type Unspecified
OR058052Medicaid