Active NPI
Gary Canova, MD
- Family Medicine Physician
- Boise, ID
National Provider Identifier
1265454680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- M4651
- Practice address
- 2993 N Cole Rd
Boise, ID 83704-5977 - Phone
- (208) 378-0400
- Fax
- (208) 378-7529
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M4651 | ID | Primary |
Addresses
Primary practice location
2993 N Cole Rd
Boise, ID 83704-5977
Mailing address
2993 N Cole Rd
Boise, ID 83704-5977
Phone (208) 378-0400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4651 | ID | MD | General Practice Dentistry |
| M4651 | ID | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1265454680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2993 N COLE RD",
"city": "BOISE",
"state": "ID",
"postal_code": "837045977",
"telephone_number": "208-378-0400",
"fax_number": "208-378-7529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2993 N COLE RD",
"city": "BOISE",
"state": "ID",
"postal_code": "837045977",
"telephone_number": "208-378-0400",
"fax_number": "208-378-7529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANOVA",
"first_name": "GARY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "M4651",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.