Healthcare Provider Details

I. General information

NPI: 1306944772
Provider Name (Legal Business Name): ALPINE EAR, NOSE & THROAT, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 E 17TH ST SUITE B
IDAHO FALLS ID
83404-8042
US

IV. Provider business mailing address

2065 E 17TH ST SUITE B
IDAHO FALLS ID
83404-8042
US

V. Phone/Fax

Practice location:
  • Phone: 208-524-7244
  • Fax: 208-524-1088
Mailing address:
  • Phone: 208-524-7244
  • Fax: 208-524-1088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK LEE CAPENER
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 208-524-7244