=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114032984
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITY EAR NOSE & THROAT PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 08/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 526 SHOUP AVE W STE M
-----------------------------------------------------
City | TWIN FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83301-5050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-734-4555
-----------------------------------------------------
Fax | 208-734-3632
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 526 SHOUP AVE W STE M
-----------------------------------------------------
City | TWIN FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83301-5050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-734-4555
-----------------------------------------------------
Fax | 208-734-3632
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | H PETER DOBLE II
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 208-734-4555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------