Organization
RETINA SPECIALISTS OF IDAHO PARTNERS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENTON R. ROBERTS MD (MANAGING PARTNER)
(208) 938-5624
Entity
Organization
Contact information
Practice address
13923 W WAINWRIGHT DR, SUITE 301, BOISE, ID 83713-1969
(208) 938-5624
(208) 938-5764
Mailing address
13923 W WAINWRIGHT DR, SUITE 301, BOISE, ID 83713-1969
(208) 938-5624
(208) 938-5764
Taxonomy
Speciality
Code
Description
License number
State
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699742395
—
ID
Enumeration date
03/26/2014
Last updated
10/14/2019
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