Individual
THEODORE STEVEN ROOSEVELT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13909 W WAINWRIGHT DR, BOISE, ID 83713-1969
(208) 389-2213
(208) 389-4659
Mailing address
13909 W WAINWRIGHT DR, BOISE, ID 83713-1969
(208) 389-2213
(208) 389-4659
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
M6142
ID
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
M6142
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002712100
—
ID
Enumeration date
01/10/2006
Last updated
05/17/2018
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