Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | O-0692 | ID |
Y | 207Q00000X | Family Doctor | O-0692 | ID |
NPI | 1073834974 |
---|---|
Provider Name | Dallas George Rindfleisch |
First Address | Idaho Falls, ID 83404-7875 |
Second Address | Idaho Falls, ID 83404-7875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2010 |
Last Update Date | 05/02/2019 |