Individual
CORY SPICER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2265 E SUNNYSIDE RD, IDAHO FALLS, ID 83404-7598
(208) 542-5000
(208) 542-5151
Mailing address
PO BOX 2671, IDAHO FALLS, ID 83403-2671
(208) 552-8761
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R74548
AZ
2085R0202X
Diagnostic Radiology Physician
12620A
WY
2085R0202X
Diagnostic Radiology Physician
Primary
M-15070
ID
2085R0202X
Diagnostic Radiology Physician
MED-PHYS-LIC-80820
MT
2085R0202X
Diagnostic Radiology Physician
R74548
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932512811
—
ID
Enumeration date
06/09/2014
Last updated
05/06/2020
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