Healthcare Provider Details

I. General information

NPI: 1073834974
Provider Name (Legal Business Name): DALLAS GEORGE RINDFLEISCH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 CHANNING WAY STE A
IDAHO FALLS ID
83404-7875
US

IV. Provider business mailing address

3155 CHANNING WAY STE A
IDAHO FALLS ID
83404-7875
US

V. Phone/Fax

Practice location:
  • Phone: 208-522-6044
  • Fax: 208-523-4862
Mailing address:
  • Phone: 208-522-6044
  • Fax: 208-523-4862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberO-0692
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-0692
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: