Individual
TED REA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1411 FALLS AVE E, STE 1151, TWIN FALLS, ID 83301-3455
(208) 933-4277
(208) 933-4280
Mailing address
1411 FALLS AVE E, STE 1151, TWIN FALLS, ID 83301-3455
(208) 732-3030
(208) 733-8970
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
M6676
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002769900
—
ID
01
—
RR MEDICARE
100016984
ID
Enumeration date
06/08/2006
Last updated
12/27/2017
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