Organization
MADISON EAR NOSE AND THROAT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBBIE SUE BULSTRODE (OFFICE MANAGER)
(208) 656-9646
Entity
Organization
Contact information
Practice address
30 MADISON PROFESSIONAL PARK, REXBURG, ID 83440-2058
(208) 656-9646
(208) 656-9645
Mailing address
30 MADISON PROFESSIONAL PARK, REXBURG, ID 83440-0828
(208) 656-9646
(208) 656-9645
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
40
ID
Other
Enumeration date
07/14/2006
Last updated
01/17/2012
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