Organization
GEM STATE RADIOLOGY LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WAYNE BALDWIN (EXECUTIVE DIRECTOR)
(208) 384-9060
Entity
Organization
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1352
(208) 367-2161
Mailing address
877 W MAIN ST STE 603, BOISE, ID 83702-6070
(208) 954-8070
(208) 954-8073
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002874800
—
ID
Enumeration date
05/29/2006
Last updated
10/31/2023
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