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General NPI Number Information
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NPI Number | 1477014207
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Entity Type | Organization
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Legal Business Name | IDAHO BARIATRIC AND METABOLIC INSTITUTE L.L.C.
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 2960 E. ST. LUKE'S ST. SUITE 200
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City | MERIDIAN
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State | ID
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Zip | 83642-9005
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Country | US
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Telephone | 208-378-4264
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Fax | 208-957-6891
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Provider Business Mailing Address
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Address Line | 2960 E. ST. LUKE'S ST. SUITE 200
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City | MERIDIAN
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State | ID
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Zip | 83642-9005
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Country | US
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Telephone | 208-378-4264
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Fax | 208-957-6891
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DAVID J BROWN
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Credential | MD
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Telephone | 208-378-4264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VB0002X
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Taxonomy Name | Obesity Medicine (Obstetrics & Gynecology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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