Individual
STANLEY MOGELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
660 SHOSHONE ST E, SUITE 110, TWIN FALLS, ID 83301-6110
(208) 732-3380
(208) 732-3300
Mailing address
660 SHOSHONE ST E, SUITE 110, TWIN FALLS, ID 83301-6110
(208) 732-3380
(208) 732-3300
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M6806
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00240855
RR MEDICARE
ID
Enumeration date
06/07/2006
Last updated
04/14/2008
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