Provider Demographics
NPI:1730153859
Name:GEIDL, RAMONA SUE (MD)
Entity type:Individual
Prefix:
First Name:RAMONA
Middle Name:SUE
Last Name:GEIDL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S MOUNTAIN VIEW RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-9205
Mailing Address - Country:US
Mailing Address - Phone:208-301-7896
Mailing Address - Fax:208-883-4404
Practice Address - Street 1:505 S MOUNTAIN VIEW RD
Practice Address - Street 2:SUITE 3
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-9205
Practice Address - Country:US
Practice Address - Phone:208-301-7896
Practice Address - Fax:208-883-4404
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806983500Medicaid
ID806983500Medicaid
H67780Medicare UPIN