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General NPI Number Information
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NPI Number | 1801306873
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Entity Type | Organization
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Legal Business Name | RICHARD J. PINES, D.O., PLLC
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 413 N ALLUMBAUGH ST STE 101
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City | BOISE
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State | ID
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Zip | 83704-9219
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Country | US
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Telephone | 208-323-1125
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Fax |
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Provider Business Mailing Address
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Address Line | 615 S GREY PINE LN
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City | BOISE
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State | ID
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Zip | 83709-2604
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Country | US
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Telephone | 208-995-9272
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Fax | 208-344-1296
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD JOHN PINES
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Credential | DO
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Telephone | 208-995-9272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0184
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License Number State | ID
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