An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is...
ID license #M-10494CA license #A95207taxonomy 207X00000X
Identifiers
Type
Value
Notes
05 (ID)
808321400
Multi-state credentialing: Licensed in 2 states. Useful context for credentialers building cross-state provider networks.
Medicare directory context
Attributes below come from the CMS Doctors & Clinicians dataset used by Medicare Care Compare,
retrieved 2026-10-12. They apply only to this clinician's public Medicare listing.
Medicare specialties
Orthopedic Surgery
Medical school
Loma Linda University School Of Medicine
Graduation year 2004
Largest Medicare group
394 members
Largest listed enrollment group
Facility affiliations reported by CMS
Kootenai Health Inc
Medicare listing data does not guarantee that a clinician is accepting new patients or that a service is covered.
View the CMS dataset →
Practice context
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
Recently enumerated nearby: 1 new orthopaedic surgery provider has been added in Post Falls in the last 180 days.
See all →
Provyx · Custom healthcare lists
Need all 243 Orthopaedic Surgery providers in Idaho?
Get the full list as a CSV with verified work emails, direct phones, and LinkedIn URLs.