Organization
EAGLE ROCK REGIONAL NEUROLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM KARL DOMARAD D.O. (PHYSICIAN)
(208) 552-5700
Entity
Organization
Contact information
Practice address
1995 E 17TH ST, STE 5, IDAHO FALLS, ID 83404-6493
(208) 552-5700
(208) 552-5703
Mailing address
1995 E 17TH ST, STE 5, IDAHO FALLS, ID 83404-6493
(208) 552-5700
(208) 552-5703
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
O343
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S5247
BLUE CROSS
ID
Enumeration date
11/28/2006
Last updated
08/22/2020
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