Individual
RICHARD A SANDISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
775 POLE LINE RD W, SUITE 105, TWIN FALLS, ID 83301-5814
(208) 814-8000
(208) 733-9402
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M6273
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003949400
—
ID
01
—
P00460908
MCRR
ID
Enumeration date
06/22/2006
Last updated
01/02/2015
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