Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | M7975 | ID |
Y | 208600000X | Surgeon | M7975 | ID |
NPI | 1023060258 |
---|---|
Provider Name | Scott A. Henson |
First Address | Boise, ID 83712-6241 |
Second Address | Meridian, ID 83642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 09/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020445995 | RAILROAD MEDICARE (01) | |
805748100 | (05) | ID |
H15703 | (02) | |
M7975 | STATE LICENSE # (01) | ID |