Healthcare Provider Details

I. General information

NPI: 1740434737
Provider Name (Legal Business Name): STEPHEN R PREECE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CHANNING WAY
IDAHO FALLS ID
83404-7533
US

IV. Provider business mailing address

2265 E SUNNYSIDE RD
IDAHO FALLS ID
83404-7598
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-6111
  • Fax:
Mailing address:
  • Phone: 208-542-5000
  • Fax: 208-542-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberM-12446
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM-12446
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: