Provider Demographics
NPI:1962728725
Name:HOEHN, ALYSSA SUSANN (MD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:SUSANN
Last Name:HOEHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3705
Mailing Address - Country:US
Mailing Address - Phone:208-549-5521
Mailing Address - Fax:208-549-7277
Practice Address - Street 1:1205 E 6TH ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3705
Practice Address - Country:US
Practice Address - Phone:208-549-5521
Practice Address - Fax:208-549-7277
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IDM-12033207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program