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General NPI Number Information
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NPI Number | 1750608105
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Entity Type | Organization
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Legal Business Name | DENNIS J PAGE PLLC
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 445 S FITNESS PL SUITE B
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City | EAGLE
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State | ID
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Zip | 83616-6828
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Country | US
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Telephone | 877-552-7884
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Fax | 877-552-7885
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Provider Business Mailing Address
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Address Line | 445 S FITNESS PL SUITE B
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City | EAGLE
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State | ID
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Zip | 83616-6828
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Country | US
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Telephone | 877-552-7884
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Fax | 877-552-7885
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Authorized Official
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Title or Position | DIRECTOR
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Name | DENNIS PAGE
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Credential | M.D.
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Telephone | 877-552-7884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | M-6970
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License Number State | ID
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