Healthcare Provider Details

I. General information

NPI: 1538276563
Provider Name (Legal Business Name): ALFRED I NARRAWAY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HOSPITAL WAY BLDG A STE 101
POCATELLO ID
83201-2753
US

IV. Provider business mailing address

PO BOX 4168
POCATELLO ID
83205-4168
US

V. Phone/Fax

Practice location:
  • Phone: 208-234-2001
  • Fax:
Mailing address:
  • Phone: 208-234-2001
  • Fax: 208-232-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberO-0457
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: