Individual
JEAN MARC CARDINAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-3810
Mailing address
PO BOX 2896, IDAHO FALLS, ID 83403-2896
(208) 552-8762
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M5908
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356423073
—
ID
01
—
P00010238
RAILROAD MEDICARE
—
Enumeration date
10/20/2006
Last updated
03/15/2017
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