Individual
JOHN RICHARD KATOVICH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
229 S 7TH STREET, ST MARIES, ID 83861
(208) 245-5551
(208) 245-9303
Mailing address
PO BOX 385, ST MARIES, ID 83861
(208) 689-3577
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M4923
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010003875
REGENCE
—
01
—
4923-9
BC
ID
Enumeration date
12/04/2006
Last updated
07/08/2007
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