Healthcare Provider Details

I. General information

NPI: 1588993018
Provider Name (Legal Business Name): DPMCALLNRID LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 BEULAHS LN
IDAHO FALLS ID
83401-2340
US

IV. Provider business mailing address

718 BEULAHS LN
IDAHO FALLS ID
83401-2340
US

V. Phone/Fax

Practice location:
  • Phone: 208-390-9631
  • Fax:
Mailing address:
  • Phone: 208-390-9631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberP-85
License Number StateID

VIII. Authorized Official

Name: CHARLES F CALL
Title or Position: OWNER
Credential: DPM
Phone: 208-390-9631