Blue Lakes Gastroenterology Pllc
NPI #1821299553 in Twin Falls, Idaho
Provider Information
- NPI Number
- 1821299553
- Entity Type
- Organization
- Organization Name
- Blue Lakes Gastroenterology Pllc
- Primary Specialty
- Nurse Practitioner
- Enumeration Date
- May 30, 2007
- Last Updated
- Mar 9, 2013
Practice Location
- Address
- 775 POLE LINE RD W
- Address 2
- SUITE 203
- City
- Twin Falls
- State
- Idaho
- ZIP Code
- 83301-5814
- Phone
- (208) 814-8300
Authorized Official
- Name
- ROBERT WARD, M.D.
- Title
- PHYSICIAN
- Phone
- (208) 814-8300
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner |
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