Provider Demographics
NPI:1538257431
Name:HINKSON, MARK E (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:HINKSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 MERLIN DR
Mailing Address - Street 2:STE 200
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7430
Mailing Address - Country:US
Mailing Address - Phone:208-528-6653
Mailing Address - Fax:208-528-6676
Practice Address - Street 1:3425 MERLIN DR
Practice Address - Street 2:STE 200
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7430
Practice Address - Country:US
Practice Address - Phone:208-528-6653
Practice Address - Fax:208-528-6676
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-323207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID10147364OtherREGENCE BLUE SHIELD OF ID
ID806894800Medicaid
ID863436OtherDESERET MUTUAL B.A.
IDS4927OtherBLUE CROSS OF IDAHO
ID806894800Medicaid
ID1302859Medicare ID - Type UnspecifiedPHYSICIAN #
ID863436OtherDESERET MUTUAL B.A.
ID1377099Medicare ID - Type UnspecifiedGROUP #