Individual
RODGER SHAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 367-2161
(208) 367-2096
Mailing address
PO BOX 9649, BOISE, ID 83707-4649
(208) 472-8100
(208) 472-8172
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M9889
ID
2085R0202X
Diagnostic Radiology Physician
MD21569
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134201
—
OR
05
—
807846800
—
ID
Enumeration date
07/13/2006
Last updated
11/13/2008
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