Individual
DR. MARK LEE CAPENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2065 E 17TH ST, SUITE B-2, IDAHO FALLS, ID 83404-8042
(208) 524-7244
(208) 524-1088
Mailing address
2065 E 17TH ST, SUITE B-2, IDAHO FALLS, ID 83404-8042
(208) 524-7244
(208) 524-1088
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
8394
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805970200
—
ID
Enumeration date
09/20/2006
Last updated
05/22/2008
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