Individual
DR. CALEB JAMES MENTZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 302-2600
(208) 302-2625
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 302-9342
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
52097
SC
2086S0102X
Surgical Critical Care Physician
52097
SC
2086S0102X
Surgical Critical Care Physician
Primary
O-1974
ID
2086S0102X
Surgical Critical Care Physician
R4098
TX
2086S0127X
Trauma Surgery Physician
076864
GA
2086S0127X
Trauma Surgery Physician
R4098
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
520976
—
SC
01
—
SCE1283365
MEDICARE PIN
SC
01
—
SCE1287628
MEDICARE PIN
SC
Enumeration date
06/28/2011
Last updated
05/14/2024
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