Northridge Internal Medicine, Pllc

NPI #1033394713 in Rexburg, Idaho

Provider Information

NPI Number: 1033394713
Entity Type: Organization
Organization Name: Northridge Internal Medicine, Pllc
Primary Specialty: Internal Medicine
Enumeration Date: Dec 31, 2007
Last Updated: Feb 11, 2008

Practice Location

Address: 36 PROFESSIONAL PLZ
Address 2: STE-102
City: Rexburg
State: Idaho
ZIP Code: 83440-2049
Phone: (208) 656-8456

Authorized Official

Name: RODNEY BATES, D.O.
Title: MEMBER
Phone: (208) 656-8456

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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