EAGLE ROCK REGIONAL NEUROLOGY P.C. NPI 1710053756

NPI Information

EAGLE ROCK REGIONAL NEUROLOGY, P.C. is a neurology psychiatry neurology in Idaho Falls, ID. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. EAGLE ROCK REGIONAL NEUROLOGY, P.C. NPI is 1710053756. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1995 E 17TH ST
STE 5
IDAHO FALLS, ID
ZIP 83404-493
Phone: (208) 552-5700
Fax: (208) 552-5703

The provider's authorized official is William Karl Domarad .
The authorized official title is Physician and has the following contact phone number (208) 552-5700.

The CLIA number assigned to this NPI record is 13D2156813 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/28/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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