Individual
REID WAYNE LOFGRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
267 N CANYON DR, GOODING, ID 83330-5500
(208) 934-4433
(208) 934-4442
Mailing address
134 W 4TH AVE, 267 NORTH CANYON DR, GOODING, ID 83330-1248
(208) 934-4446
(208) 934-4442
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
255
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518377019
NORTH CANYON MEDICAL CENTER
ID
05
—
806025500
—
ID
05
—
806777400
—
ID
Enumeration date
09/26/2006
Last updated
03/13/2015
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