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Individual

CHARLES MICHAEL RASMUSSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
520 S EAGLE RD, STE 2205, MERIDIAN, ID 83642-6308
(208) 884-0036
(208) 884-3805
Mailing address
1070 N CURTIS RD, STE 125, BOISE, ID 83706-1238
(208) 377-1415
(208) 375-3451

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
M6484
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010147672
REGENCE BLUE SHIELD OF ID
01
59907
BLUE CROSS OF IDAHO
Enumeration date
07/17/2006
Last updated
07/08/2007
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