# ROGER H. TALL M.D. P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912238544
- **Authorized official:** DR. ROGER H TALL M.D. (PRESIDENT)
- **Authorized official phone:** (208) 529-0633

## Contact information

- **Practice address:** 2001 S WOODRUFF, SUITE 8, IDAHO FALLS, ID 83404
- **Practice address phone:** (208) 529-0633
- **Practice address fax:** (208) 529-1948
- **Mailing address:** 2001 S WOODRUFF, SUITE 8, IDAHO FALLS, ID 83404
- **Mailing address phone:** (208) 529-0633
- **Mailing address fax:** (208) 529-1948

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | M4222 | ID | Yes |

## Other

- **Enumeration date:** 01/21/2010
- **Last updated:** 03/19/2010