Organization
MAGIC VALLEY PAIN SPECIALISTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER C ROE DO (OWNER)
(208) 678-7246
Entity
Organization
Contact information
Practice address
1344 HILAND AVE STE A, BURLEY, ID 83318-1564
(208) 678-7246
Mailing address
PO BOX 50979, IDAHO FALLS, ID 83405-0979
(208) 678-7246
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Enumeration date
03/10/2022
Last updated
09/27/2022
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