Individual
ROBERT DEINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11960 W BOWMONT ST, BOISE, ID 83713-6601
(208) 272-0016
Mailing address
11960 W BOWMONT ST, BOISE, ID 83713-6601
(208) 272-0016
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
311ZA0620X
—
ID
Enumeration date
03/17/2017
Last updated
03/17/2017
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