Doctor Name: | DR. WILLIAM R EDER |
NPI Number: | 1275696734 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | M3801 |
Business Practice Address: | 740 S Woodruff Ave Idaho Falls, ID - 834015285 |
Business Phone Number: | 2085429111 |
Business Fax Number: | 2085429114 |
Mailing Address: | 740 S Woodruff Ave, IDAHO FALLS |
State: | ID |
Postal Code: | 834015285 |
Phone Number: | 2085429111 |
Fax Number: | 2085429114 |
NPI Enumeration Date: | 12/18/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | M3801 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |