Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | M-14768 | ID |
N | 207RI0011X | Interventional Cardiology | 277542 | MA |
NPI | 1013202985 |
---|---|
Provider Name | Brett J. Hiendlmayr |
First Address | Idaho Falls, ID 83404-7554 |
Second Address | Idaho Falls, ID 83404-7554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2011 |
Last Update Date | 27/05/2020 |