MEDICARE: DR. DANIEL K HINCKLEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	M-5686	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821106089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL K HINCKLEY M.D.

Provider Business Mailing Address
First Line	:	2065 E 17TH ST
Second Line	:	SUITE A
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-8042
Country	:	US
Telephone Number	:	208-522-1764
Fax Number	:	208-522-1766

Provider Business Practice Location Address
First Line	:	2065 E 17TH ST
Second Line	:	SUITE A
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-8042
Country	:	US
Telephone Number	:	208-522-1764
Fax Number	:	208-522-1766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	12/10/2014

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