Individual
PETER G ROAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
207 1ST ST S, NAMPA, ID 83651-3703
(208) 466-7869
(208) 466-5359
Mailing address
3310 E RIVERNEST LN, BOISE, ID 83706-6928
(208) 869-7700
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
M-6613
ID
207RI0011X
Interventional Cardiology Physician
M-6613
ID
207RI0011X
Interventional Cardiology Physician
M6613
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010149232
BLUE SHIELD
ID
05
—
003895300
—
ID
01
—
B3390
BLUE CROSS
ID
01
—
P00182709
RAILROAD MEDICARE
ID
Enumeration date
10/21/2005
Last updated
07/22/2025
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