Individual
NATHAN LEE ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-1615
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
M-17232
ID
390200000X
Student in an Organized Health Care Education/Training Program
11020323A
IN
Other
Enumeration date
03/26/2019
Last updated
07/03/2023
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