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General NPI Number Information
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NPI Number | 1265708838
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Entity Type | Organization
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Legal Business Name | DANA L NOFZIGER MD PA
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 709 FAIR ST
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City | BUHL
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State | ID
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Zip | 83316-6442
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Country | US
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Telephone | 208-543-8237
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Fax | 208-543-8238
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Provider Business Mailing Address
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Address Line | PO BOX 629
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City | BUHL
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State | ID
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Zip | 83316-0629
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Country | US
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Telephone | 208-543-8237
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Fax | 208-543-8238
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANA L NOFZIGER
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Credential | M.D.
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Telephone | 208-543-8237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | M3722
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License Number State | ID
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