Individual
DAVID M MADDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
777 HOSPITAL WAY, SUITE 215, POCATELLO, ID 83201-5162
(208) 239-2580
Mailing address
PO BOX 4168, POCATELLO, ID 83205-4168
(208) 239-2580
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M5021
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804254800
—
ID
01
—
M5021
ID LICENSE NUMBER
—
Enumeration date
06/03/2006
Last updated
03/19/2014
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