Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | M-14612 | ID |
N | 207ND0900X | Dermatopathologist | M-14612 | ID |
NPI | 1558789560 |
---|---|
Provider Name | Brian Spencer Hoyt |
First Address | Meridian, ID 83642-6457 |
Second Address | Meridian, ID 83642-6457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2014 |
Last Update Date | 29/08/2019 |