Organization
SOUTHERN IDAHO RADIOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT WASSERSTROM M.D. (PRESIDENT)
(208) 734-1177
Entity
Organization
Contact information
Practice address
260 FALLS AVE, TWIN FALLS, ID 83301-3370
(208) 737-2192
Mailing address
PO BOX 9649, BOISE, ID 83707-4649
(208) 472-8102
(208) 344-1926
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
06/20/2006
Last updated
07/18/2007
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