DR. TRAVIS CLYDE (NPI# 1457700262) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457700262 |
| Entity Type | Individual |
| Full Name | DR. TRAVIS CLYDE |
| Credential | M.D. |
| Practice Address |
10583 W Lake Hazel Rd Boise ID 83709-6326 |
| Mailing Address |
3340 E Goldstone Dr Meridian ID 83642-1026 |
| Practice Telephone | 2083025950 |
| Practice Fax Number | 2083025955 |
| Mailing Telephone | 2083025900 |
| Mailing Fax Number | 2083025955 |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2020-11-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | M-14185 | ID | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | M-14185 | ID | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | MRM-1547 | ID | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 465 Memorial Dr, Pocatello, ID 832014008 | 2082344700 | 2082824696 |
| 301 Cedar St, Orofino, ID 835449029 | 2084765777 | 2084765385 |
| 1157 N 300 W Ste 201, Provo, UT 84604 | 8012258494 |
| Street Address |
10583 W LAKE HAZEL RD |
| City | BOISE |
| State | ID |
| Zip Code | 83709-6326 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275681256 | Daniel L Meltzer | Emergency Medicine | 10583 W Lake Hazel Rd, Boise, ID 83709 | 2007-01-08 |
| 1255957403 | Alysse Michele Weber | Nurse Practitioner | 10583 W Lake Hazel Rd, Boise, ID 83709 | 2020-06-23 |
| 1811522949 | Carmen Salyer | Nurse Practitioner | 10583 W Lake Hazel Rd, Boise, ID 83709-6326 | 2020-03-09 |
| 1760025142 | Cassandra Duncan | Nurse Practitioner | 10583 W Lake Hazel Rd, Boise, ID 83709-6326 | 2019-10-18 |
| 1013568468 | Micah Ray Tobin | Physician Assistant | 10583 W Lake Hazel Rd, Boise, ID 83709 | 2019-09-26 |
| 1689226177 | Jeffrey Kenneth Weese | Nurse Practitioner | 10583 W Lake Hazel Rd, Boise, ID 83709 | 2019-07-15 |
| 1912569351 | Sergey Kashubin | Nurse Practitioner | 10583 W Lake Hazel Rd, Boise, ID 83709-6326 | 2019-07-06 |
| 1184189839 | Eric Konkel | Physician Assistant | 10583 W Lake Hazel Rd, Boise, ID 83709 | 2019-02-06 |
| 1851855258 | Cameron J Guthrie | Physician Assistant | 10583 W Lake Hazel Rd, Boise, ID 83709 | 2019-01-30 |
| 1063983153 | Erin R Bohn | Nurse Practitioner | 10583 W Lake Hazel Rd, Boise, ID 83709-6326 | 2018-12-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427655398 | Jayme Rossow | Occupational Therapist | 101 S. Allumbaugh Way, Boise, ID 83709 | 2020-10-05 |
| 1578195285 | Kara Taylor | Counselor | 9196 W Barnes St., Boise, ID 83709 | 2020-02-11 |
| 1164080164 | Elena Stamm | Audiologist | 10000 W Amity Rd, Boise, ID 83709 | 2019-06-04 |
| 1326550096 | Lawrence D Anderson Md Estate | Optometrist | 8955 W Hackamore Dr, Boise, ID 83709 | 2017-11-02 |
| 1457879975 | Mark Aaron Phelan | Registered Nurse | 779 S. Tennyson Way, Boise, ID 83709 | 2017-09-05 |
| 1235665290 | Sharon Nelson | Dietitian, Registered | 2790 S Goshen Way, Boise, ID 83709 | 2017-05-11 |
| 1982139622 | First Choice Healthcare, Inc. | Home Health | 12400 W. Overland Rd., Ste 100, Boise, ID 83709 | 2017-05-01 |
| 1801320254 | Deborah Carson | Social Worker | 8349 West Harmonica Way, Boise, ID 83709 | 2017-04-12 |
| 1114479862 | Allyson Anne Bates | Nurse Practitioner | 10583 W Lake Hazel Road, Samg Family Medicine, Boise, ID 83709 | 2016-10-28 |
| 1508221391 | Elisha L. Garrison | Counselor | 9196 W. Barnes Street, Boise, ID 83709 | 2015-12-21 |
| Find all providers in zip 83709 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790269389 | Erin Michelle Love Mcdermott | Family Medicine | 2402 W Jefferson St, Boise, ID 83702-4811 | 2018-09-19 |
| 1336656040 | Functional Medicine of Idaho PC | Family Medicine | 3858 N Garden Center Way Ste 100, Boise, ID 83703-5008 | 2018-01-03 |
| 1922456870 | Daniel Luftig | Family Medicine | 1041 S Dale St Apt 302, Boise, ID 83706-7641 | 2016-06-01 |
| 1942676598 | Robert F. Smith, Md, Pllc | Family Medicine | 320 N Collins Rd, Boise, ID 83702-4519 | 2015-08-18 |
| 1861827222 | Treasure Valley Neuropathy Relief Center PC | Family Medicine | 1755 N Westgate Dr, Suite 200, Boise, ID 83704-7174 | 2013-09-04 |
| 1205272986 | Shahla Walizada | Family Medicine | 2141 E Parkcenter Blvd, Samg Bhp Family Medicine, Boise, ID 83706 | 2013-05-21 |
| 1891057246 | Kara Mackenzie Kuntz | Family Medicine | 5966 W Curtisian Road, Boise, ID 83704 | 2012-06-12 |
| 1922366707 | Cottonwood Family Medicine | Family Medicine | 100 Cottonwood Court, Suite 150, Boise, ID 87616 | 2012-04-30 |
| 1720377476 | Steven Schneider | Family Medicine | 3775 W Quail Hollow Dr, Boise, ID 83703-3869 | 2011-04-04 |
| 1922311042 | Amber Vania | Family Medicine | 4971 W. Overland Road, Boise, ID 83705 | 2010-07-18 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.