Individual
SCOTT R HIATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1524 12TH AVE RD, NAMPA, ID 83686-6008
(208) 463-5050
(208) 463-5040
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 463-5050
(208) 463-5040
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
O289
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149338
BLUE SHIELD
ID
05
—
806467500
—
ID
01
—
S5486
BLUE CROSS
ID
Enumeration date
10/21/2005
Last updated
05/21/2014
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