Provider Demographics
NPI:1528057445
Name:PAGE, DENNIS JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JEROME
Last Name:PAGE
Suffix:
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 1:10500 W BUSINESS PARK LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-6797
Mailing Address - Country:US
Mailing Address - Phone:208-938-0081
Mailing Address - Fax:208-938-7741
Practice Address - Street 1:10500 W BUSINESS PARK LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-6797
Practice Address - Country:US
Practice Address - Phone:208-938-0081
Practice Address - Fax:208-938-7741
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-6970207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804106000Medicaid
ID1136847Medicare ID - Type Unspecified