Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | M-14760 | ID |
Y | 208200000X | Surgeon | M-14760 | ID |
Y | 208600000X | Surgeon | M-14760 | ID |
N | 2082S0105X | Plastic Hand Surgeon | M-14760 | ID |
NPI | 1275854630 |
---|---|
Provider Name | Louis Horst Poppler |
First Address | Meridian, ID 83642-5212 |
Second Address | Meridian, ID 83642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2010 |
Last Update Date | 30/09/2019 |