Healthcare Provider Details

I. General information

NPI: 1083294227
Provider Name (Legal Business Name): COURTNEY SCOTT ISAACS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 12TH AVE RD STE 200
NAMPA ID
83686-6946
US

IV. Provider business mailing address

PO BOX 190930
BOISE ID
83719-0930
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-6800
  • Fax: 208-302-6855
Mailing address:
  • Phone: 208-302-9342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number187-T1
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-1793
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: