=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043417397
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EW GARLAND M.D. PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2007
-----------------------------------------------------
Last Update Date | 11/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3920 WASHINGTON PKWY
-----------------------------------------------------
City | IDAHO FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83404-7596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-227-0158
-----------------------------------------------------
Fax | 208-227-0159
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3920 WASHINGTON PKWY
-----------------------------------------------------
City | IDAHO FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83404-7596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-227-0158
-----------------------------------------------------
Fax | 208-227-0159
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. EW GARLAND
-----------------------------------------------------
Credential | M.D. PA
-----------------------------------------------------
Telephone | 208-227-0158
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | M5926
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------