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General NPI Number Information
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NPI Number | 1497768626
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Entity Type | Organization
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Legal Business Name | IDAHO FOOT SURGERY CENTER PC
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 1540 ELK CREEK DR.
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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 | 208-529-8393
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Fax |
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Provider Business Mailing Address
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Address Line | 1540 ELK CREEK DR.
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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 | 208-529-8393
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE G TOLMAN
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Credential | DPM
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Telephone | 208-529-8393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 1870101
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License Number State | ID
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