MR. LARRY MICHAEL OBORN (NPI# 1942219233) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942219233 |
| Entity Type | Individual |
| Full Name | MR. LARRY MICHAEL OBORN |
| Credential | PA-C |
| Practice Address |
11197 W Fairview Ave Boise ID 83713-7935 |
| Mailing Address |
Po Box 191050 Boise ID 83719-1050 |
| Practice Telephone | 2083788011 |
| Practice Fax Number | 2083228095 |
| Mailing Telephone | 2089556522 |
| Mailing Fax Number | 2089556503 |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2014-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA-1099 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
PA11201 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
11197 W FAIRVIEW AVE |
| City | BOISE |
| State | ID |
| Zip Code | 83713-7935 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053385054 | Phillip Brian Whittenberg | Physician Assistant | 11197 W Fairview Ave, Boise, ID 83713-7935 | 2006-02-15 |
| 1073083440 | Alishia Little | Physician Assistant | 11197 W Fairview Ave, Boise, ID 83713-7935 | 2018-11-28 |
| 1821529918 | Jonathan Subaitani | Emergency Medicine | 11197 W Fairview Ave, Boise, ID 83713 | 2017-03-21 |
| 1558735514 | Samuel Shinkle | Physician Assistant | 11197 W Fairview Ave, Boise, ID 83713-7935 | 2015-11-13 |
| 1538505276 | Abby M. Luensmann | Family Medicine | 11197 W Fairview Ave, Boise, ID 83713-7935 | 2013-05-21 |
| 1467787598 | Jenna Lynn Maffey | Physician Assistant | 11197 W Fairview Ave, Boise, ID 83713-7935 | 2009-10-07 |
| 1316183601 | Alliance Medical Group, LLC | Family Medicine | 11197 W Fairview Ave, Boise, ID 83713-7935 | 2008-12-17 |
| 1386664654 | Ryan A Moore | Family Medicine | 11197 W Fairview Ave, Boise, ID 83713-7935 | 2006-07-20 |
| 1215972831 | Jennifer M Vincent | Family Medicine | 11197 W Fairview Ave, Boise, ID 83713-7935 | 2006-06-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265902332 | Kidscare Home Health of Idaho, LLC | Home Health | 1835 Wildwood Street, Boise, ID 83713 | 2018-11-30 |
| 1417463928 | Kimberly Ann Bohrer | Behavioral Analyst | 12053 W Hickory Dr, Boise, ID 83713 | 2017-12-19 |
| 1407371891 | Emir Hadzic | Optometrist | 13239 W. Fernleaf St., Boise, ID 83713 | 2017-08-07 |
| 1518336650 | Alliance Physical Medicine | Nurse Practitioner | 13909 W Wainwright Drive, Boise, ID 83713 | 2015-09-18 |
| 1083038335 | Jan L Rehder | Nurse Practitioner | 13150 W Persimmon Lane, Boise, ID 83713 | 2014-02-06 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1659667459 | Jayson Clark | Dentist | 4274 N Eagle Road, Boise, ID 83713 | 2011-06-21 |
| 1043503659 | Steven Anthony Eckhoff | Physician Assistant | 11662 W Arlen St, Boise, ID 83713 | 2011-05-16 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1699930404 | Dennis J. Garpetti, Dds, P.C. | Dentist | 13108 West Persimmon Lane, Boise, ID 83713 | 2008-07-21 |
| Find all providers in zip 83713 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073915963 | Jessica Bishop | Physician Assistant | 1499 W Hays St, Boise, ID 83702-5029 | 2014-09-23 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1710231238 | Alaina A Mccoy | Physician Assistant | 100 E. Idaho St., Suite 400, Boise, ID 83712 | 2012-11-06 |
| 1447534821 | Addie Barnes | Physician Assistant | 900 N Liberty, Ste 101, Boise, ID 83704 | 2011-10-04 |
| 1134358104 | Eric Culbertson | Physician Assistant | 633n 4th St, Boise, ID 83702-4510 | 2009-07-10 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1598921595 | Karen B. Barrett | Physician Assistant | 6000 W. Overland Road, Firstline Medical, Boise, ID 83704 | 2008-07-30 |
| 1972672111 | Kara Mcgee | Physician Assistant | 727 E Riverpark Ln Ste 200, Boise, ID 83706-4097 | 2006-11-06 |
| 1265464036 | Sharene E Watsen | Physician Assistant | 403 South 11th St, Ste 100, Boise, ID 83702-6906 | 2006-07-06 |
| 1508802091 | Heidi R Munro | Physician Assistant | 8000 S Federal Way, Boise, ID 83716-9632 | 2006-06-22 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.