Organization
CDS,PA
Active
Other names
Pocatello Women's Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD A DYER M.D. (PRESIDENT)
(208) 232-3252
Entity
Organization
Contact information
Practice address
777 HOSPITAL WAY, BLDG A, STE 300, POCATELLO, ID 83201-5175
(208) 232-6100
(208) 239-3403
Mailing address
777 HOSPITAL WAY, BLDG A, STE 300, POCATELLO, ID 83201-5175
(208) 239-3453
(208) 239-3403
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002374200
—
ID
05
—
805212100
—
ID
01
—
8N201
BLUE CROSS
ID
01
—
CI7480
RAILROAD MEDICARE
ID
Enumeration date
05/05/2006
Last updated
10/31/2011
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