JOHN DAVID MCDERMOTT (NPI# 1689627069) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689627069 |
| Entity Type | Individual |
| Full Name | JOHN DAVID MCDERMOTT |
| Credential | P.A. |
| Practice Address |
3101 E State St Suite 2120 Eagle ID 83616 |
| Mailing Address |
190 E Bannock St Boise ID 83712-6241 |
| Practice Telephone | 2084733275 |
| Mailing Telephone | 2083812222 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2012-09-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PRA103 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366533978 | John J Mcdermott IIi | Ophthalmology | 655 E Foothill Blvd, Claremont, CA 91711-3511 | 2006-09-27 |
| 1003827353 | John R Mcdermott | Dentist | 102 Pitman Ave, Pitman, NJ 08071 | 2006-08-11 |
| 1386663854 | John P Mcdermott | Family Medicine | 21 Edward J Lempka Dr, Florida, NY 10921-1036 | 2006-07-18 |
| 1588618854 | John Charles Mcdermott | Audiologist | 2013 Ne Fremont St, Portland, OR 97212-2448 | 2006-05-20 |
| 1215930748 | John Patrick Mcdermott | Registered Nurse | 750 E Walker St Ste A, Orland, CA 95963-2222 | 2005-05-30 |
| 1467575134 | John S Mcdermott | Pharmacist | 300 Longwood Ave, Boston, MA 02115-5724 | 2007-04-09 |
| 1356459366 | John A Mcdermott | Ophthalmology | 310 E 14th St, New York, NY 10003-4201 | 2006-08-29 |
| 1265496418 | John Scott Mcdermott | Occupational Therapist | 48 Hospital Dr, Suite 2-a, Columbus, NC 28722-8516 | 2006-04-14 |
| 1235107061 | John C Mcdermott | Radiology | 600 Highland Ave, Madison, WI 53792 | 2006-03-09 |
| 1982677266 | John Mcdermott | Physician Assistant | 5955 Zeamer Ave, Elmendorf Afb, AK 99506-3702 | 2006-02-08 |
| Street Address |
3101 E STATE ST SUITE 2120 |
| City | EAGLE |
| State | ID |
| Zip Code | 83616 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194773598 | Kimberly R Tanabe | Internal Medicine | 3101 E State St, Suite 2120, Eagle, ID 83616-6232 | 2006-05-05 |
| 1801131800 | Katherine Hawkins Andrews | Physician Assistant | 3101 E State St, Ste 2120, Eagle, ID 83616-6232 | 2012-12-01 |
| 1457606832 | Jessica Ann Clark | Audiologist | 3101 E State St, Suite 2108, Eagle, ID 83616-6232 | 2012-07-20 |
| 1396970612 | Coleen D Hulbert | Family Medicine | 3101 E State St, Ste 1100, Eagle, ID 83616-6232 | 2009-05-18 |
| 1972757870 | University Professional Services | Clinic/Center | 3101 E State St, Suite 2107, Eagle, ID 83616-6232 | 2008-11-05 |
| 1801057708 | Mary Ann Z. Huntington | Internal Medicine | 3101 E State St, Suite 2120, Eagle, ID 83616-6232 | 2008-06-23 |
| 1437198884 | Susanne L Stickler | Internal Medicine | 3101 E State St, Suite 2120, Eagle, ID 83616-6232 | 2006-06-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730714049 | Care Medical Housecalls PC | Nurse Practitioner | 2040 E Holgate Ct, Eagle, ID 83616 | 2020-03-06 |
| 1629613823 | Counseling Solutions Center LLC | Marriage & Family Therapist | 2618 East Snocreek, Eagle, ID 83616 | 2019-11-12 |
| 1245726918 | Tracy Lyn Hagadorn | Midwife | 182 State Street, Eagle, ID 83616 | 2018-07-06 |
| 1861922627 | Nicholas A. Stelzner | Counselor | 2419 W. State St. Suite 8, Boise, ID 83616 | 2017-06-14 |
| 1184080210 | Gabriel Guerrero | Dermatology | 323 E Riverside Dr Ste 234, Eagle, ID 83616 | 2016-01-05 |
| 1376940668 | Cecilia Jo Hickam | Dental Hygienist | 1121 E. State Street, Suite - 102-d, Eagle, ID 83616 | 2014-12-02 |
| 1871912634 | Christine E Birch | Psychiatry & Neurology | 1032 S Bridgeway Pl Ste 110, Eagle, ID 83616 | 2014-04-09 |
| 1043552524 | Tori Croshaw | Social Worker | 372 S Eagle Rd Ste 190, Eagle, ID 83616 | 2013-03-21 |
| 1053650010 | Kellie Ann Northam | Nurse Practitioner | 192 West State Street, Eagle, ID 83616 | 2013-02-11 |
| 1437494457 | Mary Beth Roehling | Nurse Practitioner | 2040 E Hologate Ct, Eagle, ID 83616 | 2012-12-03 |
| Find all providers in zip 83616 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801370945 | Bryan David Harr | Physician Assistant | 1675 E Riverside Dr, Eagle, ID 83616-6237 | 2018-09-24 |
| 1619495033 | Myles Cox Sibley | Physician Assistant | 377 Sylvan Lake Rd Ste 210, Eagle, CO 81631-6779 | 2017-09-06 |
| 1346791613 | Kristen Leenhouts | Physician Assistant | 2582 N Eagle Rd, Eagle, ID 83616-3650 | 2016-10-20 |
| 1952441305 | Kellee J Crockett | Physician Assistant | 1032 S Bridgway Pl, Suite 100, Eagle, ID 83616 | 2007-02-07 |
| 1891206777 | Jessica Lee Wohlschlegel | Physician Assistant | 323 E Riverside Dr Ste 224, Eagle, ID 83616-6865 | 2017-10-18 |
| 1346647526 | Bradley Morris | Physician Assistant | 3217 W Bavaria St, Eagle, ID 83616-5171 | 2014-12-03 |
| 1245536119 | Rebecca C Urquhart | Physician Assistant | 377 Sylvan Lake Rd, Eagle, CO 81631 | 2011-02-09 |
| 1326357070 | Amber Ann Hackenberg | Physician Assistant | 323 E Riverside Drive, Ste 224, Eagle, ID 83616 | 2010-09-29 |
| 1588987309 | Andrew Reed Crawford | Physician Assistant | 3217 W Bavaria St, Eagle, ID 83616-5171 | 2010-03-08 |
| 1447483086 | Matthew Valley | Physician Assistant | 1605 E Riverside Dr, Eagle, ID 83616-6237 | 2009-08-31 |
| Find all providers in EAGLE | ||||
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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.