Basic Information
| Provider Information | |||||||||
| NPI: | 1750489647 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LALLY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | EMERY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11020 W AMITY RD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837095051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085621664 | ||||||||
| FaxNumber: | 2085621565 | ||||||||
| Practice Location | |||||||||
| Address1: | 709 N LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | JEROME | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833381851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083244301 | ||||||||
| FaxNumber: | 2083242224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | M8141 | ID | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No ID Information.