Theodore S Roosevelt (NPI# 1699754697, PAC ID# 1153318274) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is ENDOCRINOLOGY.
| Nation Provider ID (NPI) | 1699754697 |
| PAC ID by PECOS | 1153318274 |
| Professional Enrollment ID | I20040429000405 |
| Full Name | Theodore S Roosevelt |
| Organization Legal Name | IDAHO DIABETES AND ENDOCRINE |
| Address |
13909 W Wainwright Dr Boise ID 83713-1969 |
| Phone Number | 2083892213 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF UTAH SCHOOL OF MEDICINE |
| Graduation Year | 1974 |
| Primary Specialty | ENDOCRINOLOGY |
| Secondary Specialties | INTERNAL MEDICINE |
| Group Practice PAC ID | 6507902582 |
| Number of Group Practice Members | 2 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 130007 | SAINT ALPHONSUS REGIONAL MEDICAL CENTER |
| 130071 | ST LUKE'S NAMPA MEDICAL CENTER |
| 130006 | ST LUKE'S REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 13909 W Wainwright Dr, Boise, ID 83713-1969 | 2083892213 | IDAHO DIABETES AND ENDOCRINE |
| Organization Legal Name | IDAHO DIABETES AND ENDOCRINE |
| Physicians | 2 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sarah Marie Lane | Physician Assistant | Idaho Diabetes and Endocrine | 13909 W Wainwright Dr, Boise, ID 83713-1969 |
| Street Address |
13909 W WAINWRIGHT DR |
| City | BOISE |
| State | ID |
| Zip | 83713-1969 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sarah Marie Lane | Physician Assistant | Idaho Diabetes and Endocrine | 13909 W Wainwright Dr, Boise, ID 83713-1969 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kory L Kreusel | Chiropractic | 5418 N Eagle Rd, Suite 120, Boise, ID 83713-0103 | |
| Nicole Anna Thomas | Optometry | Mcneel Eye Center, Inc. | 4270 N Eagle Rd, Boise, ID 83713-0726 |
| Brian J Mcneel | Optometry | Mcneel Eye Center, Inc. | 4270 N Eagle Rd, Boise, ID 83713-0726 |
| Matthew J Ogle | Chiropractic | 13999 W Wainwright Dr, Suite 201, Boise, ID 83713-0727 | |
| Scott D Fletcher | Chiropractic | 5246 N Eagle Rd, Boise, ID 83713-0945 | |
| Joseph Blampied | Chiropractic | Fletcher Chiropractic Pllc | 5246 N Eagle Rd, Boise, ID 83713-0945 |
| Jillaine D Stmichel | Chiropractic | Fletcher Chiropractic Pllc | 5246 N Eagle Rd, Boise, ID 83713-0945 |
| Keri Erland | Internal Medicine | 6023 N Eagle Rd, Boise, ID 83713-0997 | |
| Mariya R Ostermiller | Physician Assistant | Treasure Valley Dermatology and Skin Cancer Center, Pllc | 6051 N Eagle Rd, Boise, ID 83713-0997 |
| Dustin Ray Portela | Dermatology | Treasure Valley Dermatology and Skin Cancer Center, Pllc | 6051 N Eagle Rd, Boise, ID 83713-0997 |
| Find all physicians in zip 83713 | |||
| City | BOISE |
| Zip Code | 83713 |
| Specialty | ENDOCRINOLOGY |
| City + Specialty | BOISE + ENDOCRINOLOGY |
Please comment or provide details below to improve the information on Theodore S Roosevelt.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.