Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | M-4745 | ID |
NPI | 1093753360 |
---|---|
Provider Name | Dr. Michael Rooney |
First Address | Lewiston, ID 83501-0816 |
Second Address | Lewiston, ID 83501-2431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002649400 | (05) | ID |
10004623 | REGENCE OF IDAHO (01) | ID |
8616708 | (05) | WA |
D93694 | (02) | ID |
HB112 | BLUE CROSS OF IDAHO (01) | ID |