Organization
FRUITLAND ORTHOPEDIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN OLOF DAHLIN M.D. (OWNER)
(208) 452-2510
Entity
Organization
Contact information
Practice address
1118 NW 16TH ST, SUITE C, FRUITLAND, ID 83619-2271
(208) 452-2510
(208) 452-2513
Mailing address
1118 NW 16TH ST, SUITE C, FRUITLAND, ID 83619-2271
(208) 452-2510
(208) 452-2513
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M-6608
ID
207X00000X
Orthopaedic Surgery Physician
MD13079
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266148
—
OR
Enumeration date
10/11/2005
Last updated
08/22/2020
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