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General NPI Number Information
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NPI Number | 1457342032
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Entity Type | Individual
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Provider Name | RENE ELDIDY JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 20 9TH ST SE CENTRACARE HEALTH SYSTEM - LONG PRAIRIE
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City | LONG PRAIRIE
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State | MN
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Zip | 56347-1404
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Country | US
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Telephone | 320-732-2131
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Fax | 320-732-6913
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Provider Business Mailing Address
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Address Line | 20 9TH ST SE CENTRACARE HEALTH SYSTEM - LONG PRAIRIE
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City | LONG PRAIRIE
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State | MN
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Zip | 56347-1404
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Country | US
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Telephone | 320-732-2131
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Fax | 320-732-6913
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36275
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License Number State | MN
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