Individual
MARK E HINKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3425 MERLIN DR, STE 200, IDAHO FALLS, ID 83404-7430
(208) 528-6653
(208) 528-6676
Mailing address
3425 MERLIN DR, STE 200, IDAHO FALLS, ID 83404-7430
(208) 528-6653
(208) 528-6676
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
O-323
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10147364
REGENCE BLUE SHIELD OF ID
ID
05
—
806894800
—
ID
01
—
863436
DESERET MUTUAL B.A.
ID
01
—
S4927
BLUE CROSS OF IDAHO
ID
Enumeration date
10/10/2006
Last updated
07/09/2007
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