Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | M4860 | ID |
N | 111NI0900X | Internist | M4860 | ID |
Y | 207RA0401X | Internist - Addiction Medicine | M4860 | ID |
NPI | 1275642191 |
---|---|
Provider Name | Dr. John B Casper |
First Address | Boise, ID 83704 |
Second Address | Boise, ID 83704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 21/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C92369 | (02) | ID |