Individual
DR. JASON BALTAR RODULFA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 W IRONWOOD DR STE 175, COEUR D ALENE, ID 83814-4401
(208) 625-6300
(208) 625-6301
Mailing address
700 W IRONWOOD DR STE 175, COEUR D ALENE, ID 83814-4401
(208) 625-6309
(208) 625-6310
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
30016
WV
2085N0700X
Neuroradiology Physician
M-17337
ID
2085R0202X
Diagnostic Radiology Physician
20293
NV
2085R0202X
Diagnostic Radiology Physician
Primary
M-17337
ID
Other
Enumeration date
07/14/2014
Last updated
02/11/2026
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