Individual
PHATAMA PADAVANIJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
725 POLE LINE RD W, TWIN FALLS, ID 83301-5800
(208) 814-1600
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
17531
AL
207RX0202X
Medical Oncology Physician
Primary
M-11228
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009997765
—
AL
05
—
009997775
—
AL
05
—
009998765
—
AL
Enumeration date
05/22/2006
Last updated
08/04/2014
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