Healthcare Provider Details

I. General information

NPI: 1477014207
Provider Name (Legal Business Name): IDAHO BARIATRIC AND METABOLIC INSTITUTE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 E. ST. LUKE'S ST. SUITE 200
MERIDIAN ID
83642-9005
US

IV. Provider business mailing address

2960 E. ST. LUKE'S ST. SUITE 200
MERIDIAN ID
83642-9005
US

V. Phone/Fax

Practice location:
  • Phone: 208-378-4264
  • Fax: 208-957-6891
Mailing address:
  • Phone: 208-378-4264
  • Fax: 208-957-6891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID J BROWN
Title or Position: PHYSICIAN
Credential: MD
Phone: 208-378-4264