Provider Demographics
NPI:1912950338
Name:WOMACK, MICHAEL SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:WOMACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2225 E SOLITUDE CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-7576
Mailing Address - Country:US
Mailing Address - Phone:208-453-9962
Mailing Address - Fax:208-453-9963
Practice Address - Street 1:341 E BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6208
Practice Address - Country:US
Practice Address - Phone:208-453-9962
Practice Address - Fax:208-453-9963
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-8136174400000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No174400000XOther Service ProvidersSpecialist