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General NPI Number Information
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NPI Number | 1437240009
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Entity Type | Individual
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Provider Name | DWAINE ANTHONY TESNOHLIDEK MD
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 351 SW 9TH ST
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City | ONTARIO
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State | OR
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Zip | 97914-2639
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Country | US
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Telephone | 541-881-7184
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Fax | 541-881-7016
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone | 208-381-2222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M6508
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD18758
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License Number State | OR
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