Provider Demographics
NPI:1841280898
Name:KAISER, JOHN R (MD OB/GYN)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:KAISER
Suffix:
Gender:M
Credentials:MD OB/GYN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2222
Mailing Address - Fax:208-463-3044
Practice Address - Street 1:215 E HAWAII AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6011
Practice Address - Country:US
Practice Address - Phone:208-463-3138
Practice Address - Fax:208-463-3044
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7791207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010005666OtherBLUE SHIELD
IDJ1601OtherBLUE CROSS
ID000010147415OtherBLUE SHIELD
ID160046602OtherRAILROAD MEDICARE
ID000010005665OtherBLUE SHIELD
ID33241OtherBLUE CROSS
ID000010138574OtherBLUE SHIELD
IDB0875OtherBLUE CROSS
IDJ6584OtherBLUE CROSS
ID805527100Medicaid
ID160046602OtherRAILROAD MEDICARE
ID33241OtherBLUE CROSS
IDB0875OtherBLUE CROSS