Individual
DR. EDUARDO AVILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 782-3993
(208) 782-3994
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 782-3993
(208) 782-3994
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M-9388
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010151099
REGENCE BLUE SHEILD
ID
01
—
243412
ALTIUS OLD
ID
01
—
313067
ALTIUS
ID
01
—
75390
BLUE CROSS OLD
ID
01
—
HB400
BLUE CROSS
ID
Enumeration date
05/05/2006
Last updated
03/28/2008
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