Roy Randel Henneberg in Coeur D Alene - Specialist
Roy Randel Henneberg - NPI 1114956216
Roy Randel Henneberg is a Specialist in Coeur D Alene, Idaho. Roy Randel Henneberg practices all healthcare services and medical treatments related to Specialist. The NPI Number for Roy Randel Henneberg is 1114956216. The last update date is 2020-05-14.
Roy Randel Henneberg's current location address is 980 W Ironwood Dr Ste 201, Coeur D Alene, Idaho. You can contact this provider via phone number 2087654888 and fax number 2086678618. The mailing address for Roy Randel Henneberg is 980 W Ironwood Dr Ste 201, Coeur D Alene, Idaho. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Roy Randel Henneberg |
|---|---|
| Address | 980 W Ironwood Dr Ste 201, Coeur D Alene, Idaho |
| Phone Number | 2087654888 |
| Fax Number | 2086678618 |
| Sole Proprietor | N |
| Credentials | MD |
NPI Number Detail
| NPI Number | 1114956216 |
|---|---|
| Provider Enumeration Date | 2006-07-01 |
| Last Updated Date | 2020-05-14 |
Provider Mailing Address Detail
| Address | 980 W Ironwood Dr Ste 201 |
|---|---|
| City | Coeur D Alene |
| State | Idaho (ID) |
| Post Code | 838142668 |
| Phone Number | 2087654888 |
| Fax Number | 2086678618 |
Provider's Primary Taxonomy Detail
| Speciality | Specialist |
|---|---|
| Taxonomy | 174400000X |
| Licence No | M4722 |
|
Definition: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1684500 | ID | -- |
Post Comment/ Review Below
What is the unique identification code assigned to Roy Randel Henneberg by the Centers for Medicare & Medicaid Services?
The Roy Randel Henneberg has been issued the NPI (National Provider Identifier) 1114956216. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you share the physical location details of Roy Randel Henneberg?
The Roy Randel Henneberg is situated at 980 W Ironwood Dr Ste 201, in the city of Coeur D Alene, state of ID, with the zip code 838142668.
What is Roy Randel Henneberg's primary field of medical specialization, and what is the corresponding taxonomy classification code for this area of expertise?
The primary field of medical specialization for Roy Randel Henneberg is Specialist, and the taxonomy classification code that categorizes this area of expertise is 174400000X.
On what date did the Roy Randel Henneberg receive the assignment of its 1114956216 from the Centers for Medicare & Medicaid Services?
The Roy Randel Henneberg was issued its 1114956216 by the Centers for Medicare & Medicaid Services on 2006-07-01.
As of what date were the Roy Randel Henneberg's details last updated?
The information pertaining to the Roy Randel Henneberg, including its address, specialty, and other details, was most recently updated on 2020-05-14.