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General NPI Number Information
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NPI Number | 1942499165
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Entity Type | Organization
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Legal Business Name | ALAN OLMSTEAD MD CHTD
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 844 WASHINGTON ST N SUITE 100
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City | TWIN FALLS
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State | ID
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Zip | 83301-3874
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Country | US
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Telephone | 208-734-6800
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Fax | 208-735-1635
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Provider Business Mailing Address
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Address Line | 844 WASHINGTON ST N SUITE 100
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City | TWIN FALLS
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State | ID
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Zip | 83301-3874
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Country | US
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Telephone | 208-734-6800
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Fax | 208-735-1635
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. ALAN D OLMSTEAD
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Credential | M.D.
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Telephone | 208-734-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | M-4775
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License Number State | ID
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