Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | O-163 | ID |
N | 207VE0102X | Reproductive Endocrinologist | O-163 | ID |
N | 208D00000X | General Practice Physician | 0-163 | ID |
NPI | 1629101928 |
---|---|
Provider Name | David Reed Hadlock |
First Address | Twin Falls, ID 83301-4563 |
Second Address | Twin Falls, ID 83301-4563 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 06/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004312000 | (05) | ID |
G24178 | (02) | ID |