Stoker, Brek David
Stoker, Brek David is an individual health care provider with primary practice located at 13176 W Persimmon Ln #120, Boise ID 83713-1986. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Stoker, Brek David can be contacted via phone (208) 376-3591.Contact Information
Primary practice address
13176 W Persimmon Ln #120
Boise ID 83713-1986
Phone: (208) 376-3591
Fax: (208) 376-3594
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | H-412 | Idaho |
Profile Details
| NPI number | 1609822402 |
|---|---|
| LBN Legal business name | Stoker, Brek David |
| Credentials | AUD, CCC-A |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 25th, 2006 |
| Last updated | Mar 31st, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1609822402 | NPPES |
| Idaho | Other | 000010143649 | BLUE SHIELD OF ID |
| Idaho | MEDICAID | 805959200 | BLUE SHIELD OF ID |
| Idaho | Other | AU571 | BLUE SHIELD OF ID |
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