Healthcare Provider Details

I. General information

NPI: 1932136512
Provider Name (Legal Business Name): CASEY I HUNTSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 WASHINGTON PARKWAY
IDAHO FALLS ID
83404-7592
US

IV. Provider business mailing address

3300 WASHINGTON PARKWAY
IDAHO FALLS ID
83404-7592
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-6662
  • Fax: 208-522-0880
Mailing address:
  • Phone: 208-522-6662
  • Fax: 208-522-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM8232
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: