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NPI Code Detail

MEDICARE: DENNIS J PAGE PLLC

MEDICARE: DENNIS J PAGE PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistM-6970ID

General Provider Information

NPI Number : 1750608105
Entity Type Code : Organization
Provider Name (Legal Business Name) : DENNIS J PAGE PLLC
Provider Business Mailing Address
First Line : 445 S FITNESS PL
Second Line : SUITE B
City : EAGLE
State : ID
Zip : 83616-6828
Country : US
Telephone Number : 877-552-7884
Fax Number : 877-552-7885
Provider Business Practice Location Address
First Line : 445 S FITNESS PL
Second Line : SUITE B
City : EAGLE
State : ID
Zip : 83616-6828
Country : US
Telephone Number : 877-552-7884
Fax Number : 877-552-7885
Authorized Official
Title or Position : DIRECTOR
Name : DENNIS PAGE
Credential : M.D.
Telephone Number : 877-552-7884
Provider Enumeration Date : 04/26/2010
Last Update Date : 04/26/2010

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