Healthcare Provider Details

I. General information

NPI: 1730313586
Provider Name (Legal Business Name): DAVID R. HULBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 MCGRATH RD
EAGLE ID
83616-6243
US

IV. Provider business mailing address

PO BOX 191050
BOISE ID
83719-1050
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-8200
  • Fax: 208-939-8222
Mailing address:
  • Phone: 208-955-6500
  • Fax: 208-955-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME113067
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: