Provider Demographics
NPI:1053379461
Name:TORO, PEGGY (MD)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:TORO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1758
Mailing Address - Country:US
Mailing Address - Phone:208-782-3990
Mailing Address - Fax:208-782-3994
Practice Address - Street 1:315 W IDAHO ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1711
Practice Address - Country:US
Practice Address - Phone:208-782-3990
Practice Address - Fax:208-782-3994
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-8772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010149456OtherREGENCE BLUE SHIELD
ID73924OtherBLUE CROSS OLD
ID268231OtherALTIUS OLD
ID313068OtherALTIUS
ID76962OtherBLUE CROSS
ID806699000Medicaid
ID313068OtherALTIUS
ID806699000Medicaid
ID1115126Medicare PIN
ID000010149456OtherREGENCE BLUE SHIELD
ID76962OtherBLUE CROSS