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General NPI Number Information
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NPI Number | 1083354039
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Entity Type | Individual
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Provider Name | JOHN KODATT MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 1510 12TH AVE RD STE 200
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City | NAMPA
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State | ID
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Zip | 83686-6946
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Country | US
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Telephone | 208-302-6800
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Fax | 208-302-6855
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Provider Business Mailing Address
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Address Line | PO BOX 190930
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City | BOISE
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State | ID
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Zip | 83719-0930
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Country | US
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Telephone | 208-302-9342
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | R6281
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2171959
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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