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General NPI Number Information
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NPI Number | 1770679243
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Entity Type | Individual
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Provider Name | CARL FREEMAN WURSTER M.D,F.A.C.S.,F.I.C.S
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2316 N COLE RD STE. B
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 208-345-6949
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Fax | 208-342-7008
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Provider Business Mailing Address
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Address Line | 2316 N COLE RD STE. B
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 208-345-6949
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Fax | 208-342-7008
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | M-4925
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License Number State | ID
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