Dr Roger H Tall, MD | |
2001 S Woodruff, Suite 8, Idaho Falls, ID 83404 | |
(208) 529-0633 | |
(208) 529-1948 |
Full Name | Dr Roger H Tall |
---|---|
Gender | Male |
Speciality | Urology |
Location | 2001 S Woodruff, Idaho Falls, Idaho |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1972604494 | NPI | - | NPPES |
1912238544 | Other | ID | GROUP NPI |
1972604494 | Medicaid | ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208800000X | Urology | M4222 (Idaho) | Primary |
Entity Name | Mountain View Hospital Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1669462362 PECOS PAC ID: 4486562774 Enrollment ID: O20040527001343 |
Mailing Address | Practice Location Address |
---|---|
Dr Roger H Tall, MD 2001 S Woodruff, Suite 8, Idaho Falls, ID 83404 Ph: (208) 529-0633 | Dr Roger H Tall, MD 2001 S Woodruff, Suite 8, Idaho Falls, ID 83404 Ph: (208) 529-0633 |
Dr. Timothy Osborn Taylor, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 2330 Coronado St, Idaho Falls, ID 83404 Phone: 208-552-1234 Fax: 208-522-9580 | |
Richard Alan Blatter, D.O. Urology Medicare: Accepting Medicare Assignments Practice Location: 2001 S Woodruff Ave Ste 4, Idaho Falls, ID 83404 Phone: 208-524-4511 Fax: 208-524-4540 | |
Jared K. Manwaring, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 2375 Coronado St, Idaho Falls, ID 83404 Phone: 208-552-1234 Fax: 208-529-1948 | |
Dr. Peter M Cannon, M.D. Urology Medicare: Medicare Enrolled Practice Location: 2001 S Woodruff Ave, Suite 4, Idaho Falls, ID 83404 Phone: 208-524-4511 Fax: 208-524-4540 | |
Dr. Duncan Dwaynne Harris, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 3200 Channing Way Ste A205, Idaho Falls, ID 83404 Phone: 208-535-4580 |