Healthcare Provider Details

I. General information

NPI: 1073857991
Provider Name (Legal Business Name): VALLEY VIEW ANESTHESIA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 VISTA DR
POCATELLO ID
83201-4987
US

IV. Provider business mailing address

PO BOX 3750
SALT LAKE CITY UT
84110-3750
US

V. Phone/Fax

Practice location:
  • Phone: 208-478-1704
  • Fax:
Mailing address:
  • Phone: 800-880-3566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateID

VIII. Authorized Official

Name: DR. DANIEL MARLIN HUFF
Title or Position: ANESTHESIOLOGIST
Credential: MD
Phone: 208-406-3330