Organization
IDAHO SLEEP AND NEUROLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WADE S HARRIS MD (OWNER)
(208) 454-0567
Entity
Organization
Contact information
Practice address
1825 S KIMBALL AVE, CALDWELL, ID 83605-4828
(208) 454-0567
(208) 402-6635
Mailing address
1825 S KIMBALL AVE, CALDWELL, ID 83605-4828
(208) 454-0567
(208) 402-6635
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
M9670
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063585305
NPI
ID
05
—
807637500
—
ID
Enumeration date
02/05/2014
Last updated
02/13/2014
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