Healthcare Provider Details

I. General information

NPI: 1750331757
Provider Name (Legal Business Name): ADAM DEUTCHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 MAIN ST
SALMON ID
83467-0000
US

IV. Provider business mailing address

203 S DAISY ST
SALMON ID
83467-0000
US

V. Phone/Fax

Practice location:
  • Phone: 208-756-6212
  • Fax: 208-756-6336
Mailing address:
  • Phone: 208-756-5600
  • Fax: 208-756-4169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0424797
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR-33966
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number119790
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM-9041
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11652
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: