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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699754697 NPPES
Idaho MEDICAID 002712100

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