Provider Demographics
NPI:1902919038
Name:SARIN, GREG L (DO)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:L
Last Name:SARIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Mailing Address - Fax:
Practice Address - Street 1:200 FOREST ST
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-5256
Practice Address - Country:US
Practice Address - Phone:208-630-2470
Practice Address - Fax:208-630-2475
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT127305207X00000X
CO41689207X00000X
ID2971837207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSA665374OtherCO BCBS
CO07789777Medicaid
COP00064025Medicare PIN
COH94939Medicare UPIN
CO0470600001Medicare NSC
CO07789777Medicaid