Idaho Vascular Institute Pllc

NPI #1629007844 in Nampa, Idaho

Provider Information

NPI Number: 1629007844
Entity Type: Organization
Organization Name: Idaho Vascular Institute Pllc
Primary Specialty: Radiology - Vascular & Interventional Radiology
Enumeration Date: Jul 1, 2006
Last Updated: Aug 26, 2007

Practice Location

Address: 4400 E FLAMINGO AVE
City: Nampa
State: Idaho
ZIP Code: 83687-9203
Phone: (208) 288-4620

Authorized Official

Name: DR. DANIEL WEGNER, M.D.
Title: MEMBER
Phone: (208) 288-4620

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Radiology - Vascular & Interventional Radiology — Vascular & Interventional Radiology	2085R0204X	Primary

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