Healthcare Provider Details

I. General information

NPI: 1831129394
Provider Name (Legal Business Name): RICHARD JOHN PINES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/21/2025
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5519 N GLENWOOD ST STE 120
BOISE ID
83714-1336
US

IV. Provider business mailing address

413 N ALLUMBAUGH ST STE 101
BOISE ID
83704-9219
US

V. Phone/Fax

Practice location:
  • Phone: 208-639-2058
  • Fax: 208-582-5002
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberO184
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: