Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | LD35 | ID |
NPI | 1386875268 |
---|---|
Provider Name | Mr. Fred Elmer Giovanini |
First Address | Idaho Falls, ID 83401-3929 |
Second Address | Idaho Falls, ID 83401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2009 |
Last Update Date | 27/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010009728 | BLUE SHIELD OF IDAHO (01) | ID |
0005553418 | AETNA (01) | KY |
002725400 | (05) | ID |
0041 | DELTA DENTAL OF IDAHO (01) | ID |
1650686 | UNITED CONCORDIA (01) | PA |
753354100000 | PREMERA BLUE CROSS (01) | WA |
GD203 | BLUE CROSS OF IDAHO (01) | ID |