Provider Demographics
NPI:1184681447
Name:KLINE, DAVID H (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:KLINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4339
Mailing Address - Country:US
Mailing Address - Phone:208-344-5628
Mailing Address - Fax:208-345-2907
Practice Address - Street 1:750 WARM SPRINGS AVE STE A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6457
Practice Address - Country:US
Practice Address - Phone:208-344-5628
Practice Address - Fax:208-345-2907
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO14247207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287943Medicaid
ID004159100Medicaid
930020408OtherRR MEDICARE
ORRLIND93HOLMedicare PIN
E35413Medicare UPIN