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General NPI Number Information
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NPI Number | 1588993018
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Entity Type | Organization
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Legal Business Name | DPMCALLNRID LLC
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Dates
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Enumeration Date | 12/11/2009
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Last Update Date | 12/11/2009
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Provider Practice Location Address
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Address Line | 718 BEULAHS LN
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City | IDAHO FALLS
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State | ID
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Zip | 83401-2340
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Country | US
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Telephone | 208-390-9631
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Fax |
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Provider Business Mailing Address
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Address Line | 718 BEULAHS LN
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City | IDAHO FALLS
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State | ID
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Zip | 83401-2340
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Country | US
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Telephone | 208-390-9631
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES F CALL
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Credential | DPM
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Telephone | 208-390-9631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | P-85
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License Number State | ID
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