NPI 1265458400

Madison Ear Nose and Throat Clinic

Organisation Otolaryngology Physician Rexburg, ID

Practice location

Address: 30 Madison Professional Park, Rexburg, ID 83440-2058
Phone: (208) 656-9646
Fax: (208) 656-9645
Mailing address: 30 Madison Professional Park, Rexburg, ID 83440-0828

Authorised official

Name: Debbie Sue Bulstrode
Title: Office Manager
Phone: (208) 656-9646

Registered specialties

Otolaryngology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Y00000X Licence 40 (ID)

Other Otolaryngology providers in Idaho →

Registry record

NPI: 1265458400
Entity type: Organization
NPI issued: 14 Jul 2006
Record last updated: 17 Jan 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.