Organization
EASTERN IDAHO NEUROLOGICAL ASSOCIATES PA
Active
Organization
EASTERN IDAHO NEUROLOGICAL ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN G VINCENT MD (OWNER)
(208) 552-4823
Entity
Organization
Contact information
Practice address
2353 CORONADO DRIVE, IDAHO FALLS, ID 83404
(208) 552-4823
(208) 552-4856
Mailing address
2353 CORONADO DRIVE, IDAHO FALLS, ID 83404
(208) 552-4823
(208) 552-4856
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
M6269
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002724000
—
ID
Enumeration date
09/05/2006
Last updated
01/06/2015
Update your record
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