Provider Demographics
NPI:1316971971
Name:ALEXANDER, HERB (MD)
Entity type:Individual
Prefix:DR
First Name:HERB
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A. HERBERT
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6997
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-6997
Mailing Address - Country:US
Mailing Address - Phone:208-727-0005
Mailing Address - Fax:208-727-0001
Practice Address - Street 1:660 2ND AVE S, UNIT A
Practice Address - Street 2:
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:102-087-2700
Practice Address - Fax:208-727-0001
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-7491207XX0801X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDG64687Medicare UPIN