Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | M6757 | ID |
NPI | 1316029176 |
---|---|
Provider Name | Lynn J Stromberg |
First Address | Idaho Falls, ID 83403-1432 |
Second Address | Idaho Falls, ID 83404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G11249 | (02) |