Healthcare Provider Details

I. General information

NPI: 1275642191
Provider Name (Legal Business Name): JOHN B CASPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 N HESS ST STE 474
HAYDEN ID
83835-9827
US

IV. Provider business mailing address

9030 N HESS ST STE 474
HAYDEN ID
83835-9827
US

V. Phone/Fax

Practice location:
  • Phone: 208-514-0518
  • Fax: 208-486-4009
Mailing address:
  • Phone: 208-514-0518
  • Fax: 208-486-4009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM4860
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberM4860
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: