Provider Demographics
NPI:1720089527
Name:HIGHTOWER, DAVID P (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:HIGHTOWER
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 1:4425 W AZURE TEAL LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-2170
Mailing Address - Country:US
Mailing Address - Phone:208-841-8412
Mailing Address - Fax:
Practice Address - Street 1:190 E BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6241
Practice Address - Country:US
Practice Address - Phone:208-381-8748
Practice Address - Fax:208-381-8786
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-9719207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100270040AMedicaid
KS100270040CMedicaid
KS01674018OtherBCBS KC MO GROUP 01674018
P00191070OtherRR MEDICARE GROUP DC6712
MO206039802Medicaid
KS23279063OtherBCBS OF KC MO
930051046OtherRR MEDICARE GROUP CG8899