Organization
EAST FALLS PLASTIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID J. KANE (VP)
(801) 568-5933
Entity
Organization
Contact information
Practice address
2860 CHANNING WAY, SUITE 114A, IDAHO FALLS, ID 83404-7531
(208) 535-4565
(208) 535-4564
Mailing address
2860 CHANNING WAY, SUITE 114A, IDAHO FALLS, ID 83404-7531
(208) 535-4565
(208) 535-4564
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023267895
—
ID
05
—
1023267895
—
MT
05
—
1023267895
—
WY
05
—
808218000
—
ID
Enumeration date
09/16/2008
Last updated
02/18/2010
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