BLAKE D NIEDERHAUSER

BOISE, ID
NPI1578726683
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2085R0202X Radiology Diagnostic Radiology
(Licence: ID  M-12384)
Additional Taxonomies2085R0202X Radiology Diagnostic Radiology
(Licence: MN  104451)
2085R0202X Radiology Diagnostic Radiology
(Licence: MN  52314)
Enumeration Date2008-07-08
Last Update Date2018-01-10
Business Address
BLAKE D NIEDERHAUSER MD
190 E BANNOCK ST
BOISE, ID 83712-6241
Phone number: 208-381-2094
Mailing Address
BLAKE D NIEDERHAUSER MD
PO BOX 1108
CORVALLIS, OR 97339-1108
Phone number: 208-381-2094