Healthcare Provider Details

I. General information

NPI: 1740817378
Provider Name (Legal Business Name): PATRICK BROWN HA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 E WINDING CREEK DR
EAGLE ID
83616-7052
US

IV. Provider business mailing address

1740 N MILWAUKEE ST STE A
BOISE ID
83704-7107
US

V. Phone/Fax

Practice location:
  • Phone: 208-957-5110
  • Fax: 208-586-3326
Mailing address:
  • Phone: 208-658-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA2984
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: