Provider Demographics
NPI:1427256841
Name:CHASIN, JUDITH LAUREN (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:LAUREN
Last Name:CHASIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:J. LAUREN
Other - Middle Name:
Other - Last Name:CHASIN
Other - Suffix:
Other - Last Name Type:Professional 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:208-381-2222
Mailing Address - Fax:
Practice Address - Street 1:435 S EAGLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6067
Practice Address - Country:US
Practice Address - Phone:208-939-8200
Practice Address - Fax:208-939-8222
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM11185207Q00000X
NY222464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine