Individual
DR. DEREK B HAMBLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4815 CLEVELAND BLVD, CALDWELL, ID 83605-6501
(208) 455-3545
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD23651
OR
207Q00000X
Family Medicine Physician
Primary
M-11020
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00479099
MEDICARE RAILROAD
OR
Enumeration date
06/30/2006
Last updated
03/26/2019
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