Individual
DR. RANDAL LEE WRAALSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
762 N COLLEGE RD STE A, TWIN FALLS, ID 83301-5392
(208) 814-7150
(208) 814-7170
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
P152
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804243900
—
ID
01
—
P00899555
MCRR
ID
Enumeration date
05/24/2005
Last updated
11/05/2024
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