Healthcare Provider Details

I. General information

NPI: 1174063036
Provider Name (Legal Business Name): IAN HOTCHKISS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 12TH AVE RD STE 200
NAMPA ID
83686-6008
US

IV. Provider business mailing address

3340 E GOLDSTONE DR
MERIDIAN ID
83642
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-6800
  • Fax: 208-302-6855
Mailing address:
  • Phone: 208-302-7500
  • Fax: 208-302-7555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101023057
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-1392
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: