Provider Demographics
NPI:1588982656
Name:DACCARETT, SARAH MARIA (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MARIA
Last Name:DACCARETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MARIA
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:827 E PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-7782
Mailing Address - Country:US
Mailing Address - Phone:208-781-0412
Mailing Address - Fax:
Practice Address - Street 1:827 E PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-7782
Practice Address - Country:US
Practice Address - Phone:208-781-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7633610-1205207ZC0006X
ORMD161763207ZC0006X
IDM-12016207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology