Provider Demographics
NPI:1407925639
Name:HORROCKS, CHAD RODGER (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:RODGER
Last Name:HORROCKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 N 1ST E
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-5109
Mailing Address - Country:US
Mailing Address - Phone:208-354-2302
Mailing Address - Fax:208-354-8392
Practice Address - Street 1:283 N 1ST E
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5109
Practice Address - Country:US
Practice Address - Phone:208-354-2302
Practice Address - Fax:208-354-8392
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-7721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDG62962Medicare UPIN
ID1141928Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL