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General NPI Number Information
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NPI Number | 1760561310
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Entity Type | Individual
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Provider Name | MICHAEL C BIDDULPH MD
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Gender | Male
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 09/05/2008
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Provider Practice Location Address
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Address Line | 3100 CHANNING WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7533
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Country | US
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Telephone | 208-529-6111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2671
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City | IDAHO FALLS
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State | ID
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Zip | 83403-2671
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Country | US
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Telephone | 208-523-4906
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Fax | 208-523-2025
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | M6750
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License Number State | ID
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