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NPI Code Detail

MEDICARE: MARK L HOLBROOK M.D.

MEDICARE: MARK L HOLBROOK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianM6850ID

General Provider Information

NPI Number : 1205884616
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK L HOLBROOK M.D.
Provider Business Mailing Address
First Line : 190 E BANNOCK ST
Second Line :
City : BOISE
State : ID
Zip : 83712-6241
Country : US
Telephone Number : 208-706-8000
Fax Number : 208-706-8001
Provider Business Practice Location Address
First Line : 4840 N CLOVERDALE RD
Second Line :
City : BOISE
State : ID
Zip : 83713-2423
Country : US
Telephone Number : 208-706-8000
Fax Number : 208-706-8001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 01/23/2014

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