Healthcare Provider Details

I. General information

NPI: 1992897268
Provider Name (Legal Business Name): JAMES MICHAEL OLDROYD M D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S WOODRUFF AVE STE 10
IDAHO FALLS ID
83404-6374
US

IV. Provider business mailing address

2001 S WOODRUFF AVE STE 10
IDAHO FALLS ID
83404-6374
US

V. Phone/Fax

Practice location:
  • Phone: 208-523-2060
  • Fax: 208-523-9874
Mailing address:
  • Phone: 208-523-2060
  • Fax: 208-523-9874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberM3475
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: