Active NPI
Martin R Tubach, MD
- Otolaryngology Physician
- Boise, ID
National Provider Identifier
1982656591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- M8065
- Practice address
- 6052 W State St
Boise, ID 83703-2739 - Phone
- (208) 947-1947
- Fax
- (208) 947-1945
- NPI assigned
- May 16, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | M8065 | ID | Primary |
Addresses
Primary practice location
6052 W State St
Boise, ID 83703-2739
Mailing address
6052 W State St
Boise, ID 83703-2739
Phone (208) 947-1947
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 805751800 | Medicaid | ID |
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 |
|---|---|---|---|
| M8065 | ID | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264636800000",
"number": "1982656591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6052 W STATE ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837032739",
"telephone_number": "208-947-1947",
"fax_number": "208-947-1945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6052 W STATE ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837032739",
"telephone_number": "208-947-1947",
"fax_number": "208-947-1945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUBACH",
"first_name": "MARTIN",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-16",
"last_updated": "2010-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "ID",
"license": "M8065",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "805751800",
"state": "ID"
}
],
"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 Jan 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.