Healthcare Provider Details

I. General information

NPI: 1023947520
Provider Name (Legal Business Name): PETER L KANE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8620 W EMERALD ST STE 150
BOISE ID
83704-4839
US

IV. Provider business mailing address

5164 W STOKER LN APT 205
BOISE ID
83703-6511
US

V. Phone/Fax

Practice location:
  • Phone: 208-617-3265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: