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General NPI Number Information
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NPI Number | 1972976694
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Entity Type | Organization
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Legal Business Name | R & D ANESTHESIA
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Dates
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Enumeration Date | 11/03/2015
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Last Update Date | 07/24/2019
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Provider Practice Location Address
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Address Line | 10118 W OVERLAND RD
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City | BOISE
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State | ID
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Zip | 83709-1428
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Country | US
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Telephone | 208-887-2233
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 44163
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City | BOISE
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State | ID
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Zip | 83711-0163
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Country | US
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Telephone | 208-887-2233
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROY H ROGERS
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Credential | DDS
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Telephone | 208-871-0215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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