Individual
DR. ROGER H TALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2001 S WOODRUFF, SUITE 8, IDAHO FALLS, ID 83404
(208) 529-0633
(208) 529-1948
Mailing address
2001 S WOODRUFF, SUITE 8, IDAHO FALLS, ID 83404
(208) 529-0633
(208) 529-1948
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
M4222
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912238544
GROUP NPI
ID
05
—
1972604494
—
ID
Enumeration date
09/26/2006
Last updated
12/22/2010
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