Provider Demographics
NPI:1679766844
Name:SILL, HOWARD W (MD, PHD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:W
Last Name:SILL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3581 E OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6757
Mailing Address - Country:US
Mailing Address - Phone:208-605-7677
Mailing Address - Fax:208-605-7674
Practice Address - Street 1:3581 E OVERLAND RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6757
Practice Address - Country:US
Practice Address - Phone:208-605-7677
Practice Address - Fax:208-605-7674
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22100207Q00000X
WAMD000384522085R0204X
TXS55012085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2030768Medicaid
OR500658018Medicaid