Organization
DJ MARC CARDINAL, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DJ MARC CARDINAL MD (PRESIDENT)
(208) 785-3810
Entity
Organization
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-3810
Mailing address
PO BOX 2896, IDAHO FALLS, ID 83403-2896
(208) 523-4906
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806651100
—
ID
01
—
DG2308
RAILROAD MEDICARE GROUP
—
Enumeration date
10/20/2006
Last updated
10/20/2011
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