Healthcare Provider Details

I. General information

NPI: 1801307392
Provider Name (Legal Business Name): ROBERT ERIC CALE AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 12/27/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 MERLIN DR STE 200
IDAHO FALLS ID
83404-7489
US

IV. Provider business mailing address

3345 MERLIN DR STE 200
IDAHO FALLS ID
83404-7489
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-1514
  • Fax: 208-529-3170
Mailing address:
  • Phone: 208-529-1514
  • Fax: 208-529-3170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-2045
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberSLP-AU-LIC-11601
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD-6072
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: