Individual
ROBERT WASSERSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
260 FALLS AVE, TWIN FALLS, ID 83301-3370
(208) 737-2192
Mailing address
PO BOX 9649, BOISE, ID 83707-4649
(208) 472-8102
(208) 344-1926
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M6483
ID
Other
Enumeration date
07/11/2006
Last updated
07/18/2007
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