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General NPI Number Information
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NPI Number | 1639516180
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Entity Type | Organization
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Legal Business Name | W ALLEN RADER, MD PC
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 801 N STILSON RD
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City | BOISE
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State | ID
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Zip | 83703-5145
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Country | US
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Telephone | 208-343-3652
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Fax | 208-367-9188
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Provider Business Mailing Address
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Address Line | 801 N STILSON RD
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City | BOISE
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State | ID
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Zip | 83703-5145
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Country | US
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Telephone | 208-343-3652
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Fax | 208-367-9188
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILBUR ALLEN RADER
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Credential | MD
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Telephone | 208-343-3652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number | M7878
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License Number State | ID
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