NPI 1053493809 · live from the CMS NPI Registry
Dj Marc Cardinal, MD PA
Radiology, Diagnostic Radiology in Blackfoot, ID. National Provider Identifier 1053493809, active.
NPI record
| NPI | 1053493809 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Radiology, Diagnostic Radiology 2085R0202X |
| Practice location | 98 Poplar St, Blackfoot, ID 83221 |
| Practice phone | 208-785-3810 |
| Mailing address | Po Box 2896, Idaho Falls, ID 83403 |
| Enumerated | October 20, 2006 |
| Last updated | October 20, 2011 |
| Authorized official | Dj Cardinal, President |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Radiology, Diagnostic Radiology primary | 2085R0202X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.