| NPI | 1669918769 |
|---|---|
| Doing Business As | PEDIATRIC NEUROLOGY - IDAHO FALLS |
| Entity Type | Organization |
| Authorized Contact | EDWARD CLARK Department Chair 801-587-6336 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2020-05-21 |