Provider Demographics
NPI:1922021500
Name:KLOSS, JOHN G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:KLOSS
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 1:901 N CURTIS RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1341
Mailing Address - Country:US
Mailing Address - Phone:208-342-4263
Mailing Address - Fax:208-375-0597
Practice Address - Street 1:901 N CURTIS RD
Practice Address - Street 2:SUITE 304
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1341
Practice Address - Country:US
Practice Address - Phone:208-342-4263
Practice Address - Fax:208-375-0597
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-4164207X00000X, 207XS0106X, 207XS0114X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003785200Medicaid
ID6215700001Medicare NSC
1117058Medicare PIN
D93710Medicare UPIN
P00204981Medicare PIN
ID11170561Medicare PIN