Provider Demographics
NPI:1689715864
Name:DROGE, EDDIE (MD)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:
Last Name:DROGE
Suffix:
Gender:M
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:PO BOX 1047
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-1047
Mailing Address - Country:US
Mailing Address - Phone:208-634-2225
Mailing Address - Fax:208-634-7212
Practice Address - Street 1:211 FOREST ST
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638
Practice Address - Country:US
Practice Address - Phone:208-634-2225
Practice Address - Fax:208-634-7212
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM2891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010001142OtherBS SRMC
ID28910OtherBC PLMC
IDD7555OtherBC SRMC
ID000010001143OtherBS PLMC
ID28910OtherBC PLMC
ID1103356Medicare PIN