Healthcare Provider Details

I. General information

NPI: 1952314593
Provider Name (Legal Business Name): LEE J HIXSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 6TH ST
LEWISTON ID
83501
US

IV. Provider business mailing address

6360 S 3000 E STE 220
SALT LAKE CITY UT
84121-6924
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-3998
  • Fax: 208-746-4879
Mailing address:
  • Phone: 801-944-3195
  • Fax: 801-944-3180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberM-13080
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number166940-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: