Individual
NIKOLAUS KONRAD NEUDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 POLE LINE RD W, TWIN FALLS, ID 83301-5810
(208) 814-4100
(208) 814-4908
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M-17802
ID
Other
Enumeration date
04/09/2020
Last updated
08/07/2024
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