| Peter G Roan, MD | |
|
4424 E Flamingo Ave, Suite 300, Nampa, ID 83687-9306 | |
| (208) 302-0200 | |
| (208) 302-0255 |
| Full Name | Peter G Roan |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine - Interventional Cardiology |
| Location | 4424 E Flamingo Ave, Nampa, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326037342 | NPI | - | NPPES |
| 003895300 | Medicaid | ID | |
| 000010149232 | Other | ID | BLUE SHIELD |
| P00182709 | Other | ID | RAILROAD MEDICARE |
| B3390 | Other | ID | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0011X | Internal Medicine - Interventional Cardiology | M6613 (Idaho) | Secondary |
| 207RI0011X | Internal Medicine - Interventional Cardiology | M-6613 (Idaho) | Primary |
| Entity Name | Saint Alphonsus Medical Center Nampa Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1659371870 PECOS PAC ID: 7113821026 Enrollment ID: O20031121000788 |
| Entity Name | Saint Alphonsus Regional Medical Center Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1649357716 PECOS PAC ID: 3476462359 Enrollment ID: O20040204001036 |
| Entity Name | St Joseph Hospital Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1205368404 PECOS PAC ID: 8325325806 Enrollment ID: O20170606002496 |
| Mailing Address | Practice Location Address |
|---|---|
| Peter G Roan, MD 3340 E Goldstone Way, Meridian, ID 83642-1026 Ph: (208) 302-0200 | Peter G Roan, MD 4424 E Flamingo Ave, Suite 300, Nampa, ID 83687-9306 Ph: (208) 302-0200 |
Wesley David Pidcock, DO Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 4400 E Flamingo Ave Ste 200, Nampa, ID 83687 Phone: 208-302-2100 Fax: 208-302-2125 | |
Kenneth Wilhelm Jr., Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 4400 E Flamingo Ave, Nampa, ID 83687 Phone: 208-288-4970 Fax: 208-288-4990 | |
Michael M Dee, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 215 E Hawaii Ave, Nampa, ID 83686 Phone: 208-463-3234 Fax: 208-463-3044 | |
Justin Tomal, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 1200 Garrity Blvd, Nampa, ID 83687 Phone: 208-343-6458 | |
Braden Lawrence, MD Internal Medicine Medicare: Medicare Enrolled Practice Location: 85 S Middleton Rd, Nampa, ID 83651 Phone: 208-381-4100 | |
Ryan J. Williams, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 900 N Happy Valley Rd, Nampa, ID 83687 Phone: 208-401-9639 | |
Nicholas W. Hodgman, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 4424 E Flamingo Ave, Ste 300, Nampa, ID 83687 Phone: 208-302-0200 Fax: 208-302-0255 |