Individual
DR. DENNIS M ENOMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
775 POLE LINE RD W, SUITE 112, TWIN FALLS, ID 83301-5814
(208) 814-8200
(208) 933-4921
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
M9612
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807509100
—
ID
01
—
P00431080
RR MEDICARE
ID
Enumeration date
05/26/2006
Last updated
12/29/2014
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