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Organization
IDAHO DIABETES AND ENDOCRINE ASSOCIATES, PA
Active
Organization
IDAHO DIABETES AND ENDOCRINE ASSOCIATES, PA
Active
Other names
Idaho Diabetes & Endocrine Associates, PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THEODORE S ROOSEVELT MD, PHD, JD (PRESIDENT)
(208) 389-2213
Entity
Organization
Contact information
Practice address
13909 W. WAINWRIGHT DRIVE, BOISE, ID 83713-1969
(208) 389-2213
(208) 389-4659
Mailing address
13909 W. WAINWRIGHT DRIVE, BOISE, ID 83713-1969
(208) 389-2213
(208) 389-4659
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
NULL
174400000X
Specialist
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
NULL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Enumeration date
01/07/2008
Last updated
05/18/2022
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