Provider Demographics
NPI:1689604993
Name:HONSINGER, BRUCE WHITLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WHITLEY
Last Name:HONSINGER
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 1:420 N 2ND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1552
Mailing Address - Country:US
Mailing Address - Phone:208-263-2173
Mailing Address - Fax:208-263-7441
Practice Address - Street 1:420 N 2ND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1552
Practice Address - Country:US
Practice Address - Phone:208-263-2173
Practice Address - Fax:208-263-7441
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4237207V00000X
WAMD00037242207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003747800Medicaid
ID1116051Medicare ID - Type Unspecified
ID003747800Medicaid