Roosevelt, Theodore Steven
Roosevelt, Theodore Steven is an sole proprietor health care provider with primary practice located at 13909 W Wainwright Dr , Boise ID 83713-1969. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism. Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism is his primary health care specialty. Roosevelt, Theodore Steven can be contacted via phone (208) 389-2213.Contact Information
Primary practice address
13909 W Wainwright Dr
Boise ID 83713-1969
Phone: (208) 389-2213
Fax: (208) 389-4659
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | M6142 | Idaho |
| Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism | 207RE0101X | M6142 | Idaho |
Profile Details
| NPI number | 1699754697 |
|---|---|
| LBN Legal business name | Roosevelt, Theodore Steven |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 10th, 2006 |
| Last updated | May 17th, 2018 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1699754697 | NPPES |
| Idaho | MEDICAID | 002712100 |
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