Healthcare Provider Details

I. General information

NPI: 1740553361
Provider Name (Legal Business Name): AARON J ALTENBURG MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 E CENTER ST
POCATELLO ID
83201
US

IV. Provider business mailing address

2240 E CENTER ST
POCATELLO ID
83201
US

V. Phone/Fax

Practice location:
  • Phone: 208-233-8344
  • Fax: 208-233-6983
Mailing address:
  • Phone: 208-233-8344
  • Fax: 208-233-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM-10209
License Number StateID

VIII. Authorized Official

Name: AARON JOHN ALTENBURG
Title or Position: OWNER
Credential: MD
Phone: 208-233-8344