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Specialty details in registry · Ammon, ID

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At a glance

3840 E Sunnyside Rd, Ammon, ID 83406-7922

NPPES record updated Feb 9, 2011. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

3840 E Sunnyside Rd
Ammon, ID 83406-7922

Professional details: NPI, taxonomy & registry record

NPI1154627099

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 310400000X
Enumeration date: Feb 9, 2011
Record updated: Feb 9, 2011

More registry details

Provider type: Organization · Type 2
Other reported name: <UNAVAIL>

Reported taxonomies and licenses

Specialty details in registry

310400000X · Primary

License reported: RC 992 ID

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

3840 E Sunnyside Rd
Ammon, ID 83406-7922

Phone: (208) 529-1818
Fax: (208) 529-1734

Mailing address

4538 TANGLEWOOD DR

HOLLADAY, UT 841174219

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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