Healthcare Provider Details

I. General information

NPI: 1184681447
Provider Name (Legal Business Name): DAVID H KLINE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WARM SPRINGS AVE STE A
BOISE ID
83712-6457
US

IV. Provider business mailing address

1007 N 6TH ST
BOISE ID
83702-4339
US

V. Phone/Fax

Practice location:
  • Phone: 208-344-5628
  • Fax: 208-345-2907
Mailing address:
  • Phone: 208-344-5628
  • Fax: 208-345-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO14247
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: