Organization
BLUE LAKES GASTROENTEROLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT WARD M.D. (PHYSICIAN)
(208) 814-8300
Entity
Organization
Contact information
Practice address
775 POLE LINE RD W, SUITE 203, TWIN FALLS, ID 83301-5814
(208) 814-8300
(208) 733-8970
Mailing address
775 POLE LINE RD W, SUITE 203, TWIN FALLS, ID 83301-5814
(208) 814-8300
(208) 733-8970
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
M6665
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806237600
—
ID
01
—
CJ6218
RR MEDICARE
ID
Enumeration date
06/01/2006
Last updated
03/09/2013
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