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Organization
RICHARD RADNOVICH DO PC
Active
Organization
RICHARD RADNOVICH DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD G RADNOVICH D.O. (OWNER)
(208) 939-2100
Entity
Organization
Contact information
Practice address
4850 N ROSEPOINT WAY, SUITE 100, BOISE, ID 83713-5262
(208) 939-2100
(208) 939-4411
Mailing address
4850 N ROSEPOINT WAY, SUITE 100, BOISE, ID 83713-5262
(208) 939-2100
(208) 939-4411
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010139957
REGENCE BLUE SHIELD OF ID
ID
01
—
S3978
BLUE CROSS OF IDAHO
ID
Enumeration date
09/18/2007
Last updated
09/18/2007
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