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NPI Code Detail

MEDICARE: CORY ONDLER D.O.

MEDICARE:   CORY  ONDLER  D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine PhysicianO-0903ID
2207P00000XEmergency Medicine PhysicianDO167057OR

General Provider Information

NPI Number : 1457641342
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORY ONDLER D.O.
Provider Business Mailing Address
First Line : 1202 E LOCUST ST
Second Line :
City : EMMETT
State : ID
Zip : 83617-2715
Country : US
Telephone Number : 208-365-3561
Fax Number :
Provider Business Practice Location Address
First Line : 1202 E LOCUST ST
Second Line :
City : EMMETT
State : ID
Zip : 83617-2715
Country : US
Telephone Number : 208-365-3561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2011
Last Update Date : 01/27/2016

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Directions to “ CORY ONDLER D.O.” Practice Location

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