Organization
EASTERN IDAHO CARDIOLOGY ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK D GORMAN M.D. (CEO)
(208) 524-2255
Entity
Organization
Contact information
Practice address
2001 S WOODRUFF AVE, SUITE 12A, IDAHO FALLS, ID 83404-6374
(208) 524-2255
(208) 524-2256
Mailing address
2001 S WOODRUFF AVE, SUITE 12A, IDAHO FALLS, ID 83404-6374
(208) 524-2255
(208) 524-2256
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805326000
—
ID
Enumeration date
07/26/2005
Last updated
07/21/2022
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