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Individual

DR. SALVATORE DI RAFFAELE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C, D.C.

Contact information

Practice address
1090 W PARK PL, COEUR D ALENE, ID 83814-2785
(208) 415-0299
Mailing address
PO BOX 1387, HAYDEN, ID 83835-1387
(208) 415-0299

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
14822
CA
363A00000X
Physician Assistant
Primary
2005
ID
363AM0700X
Medical Physician Assistant
2005
ID

Other

Enumeration date
01/15/2007
Last updated
07/10/2023
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