Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | M6824 | ID |
NPI | 1114977600 |
---|---|
Provider Name | Roy Tyler Frizzell |
First Address | Boise, ID 83712-6241 |
Second Address | Boise, ID 83702-6109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 31/07/2013 |