Provider Demographics
NPI:1679512982
Name:RAND, THOMAS H (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:RAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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:208-381-7330
Mailing Address - Fax:208-381-7331
Practice Address - Street 1:100 E IDAHO ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6267
Practice Address - Country:US
Practice Address - Phone:208-381-7330
Practice Address - Fax:208-381-7331
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM61092080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003904800Medicaid
ID003904800Medicaid
1129158Medicare ID - Type Unspecified
ID20000563Medicare PIN