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Organization
TONY C ROISUM MD PA
Active
Organization
TONY C ROISUM MD PA
Active
Other names
Idaho Falls Family & Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE KELSEY (OFFICE MANAGER)
(208) 524-3416
Entity
Organization
Contact information
Practice address
3360 WASHINGTON PKWY, SUITE 1, IDAHO FALLS, ID 83404-8333
(208) 524-3416
(208) 524-3138
Mailing address
3360 WASHINGTON PKWY STE 1, IDAHO FALLS, ID 83404-7592
(208) 524-3416
(208) 524-3138
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M7389
ID
207QS0010X
Sports Medicine (Family Medicine) Physician
M7389
ID
Other
Enumeration date
10/05/2006
Last updated
01/16/2026
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