Healthcare Provider Details

I. General information

NPI: 1750537205
Provider Name (Legal Business Name): MARK E HOOSTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 FAIRVIEW AVE STE 350
CALDWELL ID
83605-5425
US

IV. Provider business mailing address

1906 FAIRVIEW AVE STE 350
CALDWELL ID
83605-5425
US

V. Phone/Fax

Practice location:
  • Phone: 208-505-2101
  • Fax: 208-505-2102
Mailing address:
  • Phone: 208-505-2101
  • Fax: 208-505-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-14671
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: