Provider Demographics
NPI:1992789564
Name:ADER, JOHN T (DO-RHEUMATOLOGY)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:ADER
Suffix:
Gender:M
Credentials:DO-RHEUMATOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5178 N MORNINGGALE WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1453
Mailing Address - Country:US
Mailing Address - Phone:833-767-4386
Mailing Address - Fax:833-874-0554
Practice Address - Street 1:784 S CLEARWATER LOOP STE B
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9599
Practice Address - Country:US
Practice Address - Phone:833-767-4386
Practice Address - Fax:833-874-0554
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9114207R00000X, 207RR0500X
IDO-0634207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1992789564Medicaid
ID1992789564Medicaid
MIH88553Medicare UPIN
MIM40150069Medicare PIN
MI4517667Medicaid