Healthcare Provider Details

I. General information

NPI: 1396824819
Provider Name (Legal Business Name): BRIAN R HOBBS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 CORONADO ST
IDAHO FALLS ID
83404-7407
US

IV. Provider business mailing address

PO BOX 3206
IDAHO FALLS ID
83403-3206
US

V. Phone/Fax

Practice location:
  • Phone: 208-557-2700
  • Fax:
Mailing address:
  • Phone: 208-523-4906
  • Fax: 208-523-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA200
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: