Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

St Lukes Regional Med Ctr Dba St Lukes Pediatric Surgery of Idaho

Organization Pediatric Surgery Physician · NPI 1720204738

St Lukes Regional Med Ctr Dba St Lukes Pediatric Surgery of Idaho is a Pediatric Surgery Physician in Boise, Idaho. Registered with an NPI since 2007.

In the registry since
2007

Practice location Address checks out

100 E Idaho St Ste 300
Boise, ID 83712-6223
Phone: (208) 345-5400
Fax: (208) 345-5454
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Surgery Physician (primary) Taxonomy 2086S0120X

Record details

NPI number1720204738
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Carrie Cowgill — Credentialing Coordinator · (208) 381-4137
NPI enumeratedApril 18, 2007
Last updated in NPPESApril 9, 2008
Mailing address100 E Idaho St, Suite 300, Boise, ID 83712-6223

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