| Doctor Name: | GLEN R ALBERTSON |
| NPI Number: | 1952462681 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D |
| License Number: | 282NC0060X |
| Business Practice Address: | 1120 Montana St Gooding, ID - 833301858 |
| Business Phone Number: | 2089344433 |
| Business Fax Number: | 2089348643 |
| Mailing Address: | 1120 Montana St, Po Box 481 GOODING |
| State: | ID |
| Postal Code: | 833301858 |
| Phone Number: | 2089344433 |
| Fax Number: | 2089348643 |
| NPI Enumeration Date: | 12/13/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NC0060X |
| License Number: | 282NC0060X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Critical Access |
| Taxonomy Definition: | |