Provider Demographics
NPI:1881620680
Name:DOBLE, H PETER II (MD)
Entity type:Individual
Prefix:
First Name:H
Middle Name:PETER
Last Name:DOBLE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 SHOUP AVE W STE M
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5050
Mailing Address - Country:US
Mailing Address - Phone:208-734-4555
Mailing Address - Fax:208-734-3632
Practice Address - Street 1:526 SHOUP AVE W STE M
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5050
Practice Address - Country:US
Practice Address - Phone:208-734-4555
Practice Address - Fax:208-734-3632
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5706174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID640005710OtherRAILROAD MEDICARE IND #
ID003659500Medicaid
ID57067OtherBLUE CROSS
ID000010003660OtherREGENCE BLUE SHIELD
IDM5706OtherIDAHO MEDICAL LICENSE
ID640005710OtherRAILROAD MEDICARE IND #
IDM5706OtherIDAHO MEDICAL LICENSE