Wraalstad, Randal Lee

Wraalstad, Randal Lee is an individual health care provider with primary practice located at 714 N College Rd Suite A, Twin Falls ID 83301-5812. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Wraalstad, Randal Lee can be contacted via phone (208) 814-7150.

Contact Information

Primary practice address
714 N College Rd Suite A Twin Falls ID 83301-5812
Phone: (208) 814-7150
Fax: (208) 814-7170
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X P152 Idaho

Profile Details

NPI number 1255334066
LBN Legal business name Wraalstad, Randal Lee
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2005
Last updated Jan 2nd, 2015 - about 9 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255334066 NPPES
Idaho MEDICAID 804243900
Idaho Other P00899555

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