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General NPI Number Information
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NPI Number | 1124252952
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Entity Type | Organization
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Legal Business Name | CRAIG D SCOVILLE, MD, PC
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 11/02/2009
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Provider Practice Location Address
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Address Line | 2220 E. 25TH STREET
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-542-9080
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Fax | 208-542-9081
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Provider Business Mailing Address
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Address Line | 2220 E. 25TH STREET
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-542-9080
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Fax | 208-542-9081
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRAIG D SCOVILLE
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Credential | MD
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Telephone | 208-542-9080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | M5232
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License Number State | ID
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