Provider Demographics
NPI:1851808133
Name:ROCKY MOUNTAIN PHYSICIAN GROUP LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN PHYSICIAN GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DALLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-374-7200
Mailing Address - Street 1:PO BOX 64568
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-4568
Mailing Address - Country:US
Mailing Address - Phone:480-374-7200
Mailing Address - Fax:480-585-0051
Practice Address - Street 1:777 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5175
Practice Address - Country:US
Practice Address - Phone:480-421-9700
Practice Address - Fax:480-421-9700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY MOUNTAIN EMERGENCY PHYSICIANS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-08
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty