Provider Demographics
NPI:1073834974
Name:RINDFLEISCH, DALLAS GEORGE (DO)
Entity Type:Individual
Prefix:
First Name:DALLAS
Middle Name:GEORGE
Last Name:RINDFLEISCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 CHANNING WAY STE A
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7875
Mailing Address - Country:US
Mailing Address - Phone:208-522-6044
Mailing Address - Fax:208-523-4862
Practice Address - Street 1:3155 CHANNING WAY STE A
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7875
Practice Address - Country:US
Practice Address - Phone:208-522-6044
Practice Address - Fax:208-523-4862
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0692207KA0200X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty