Search › Idaho › 363LF0000X
Glade Southam, NP
NPI 1588654628 · on the registry since 2005
Practice
- Address
- Byu - Idaho
100 Shc
Rexburg, ID 83460 - Phone
- (208) 496-1300
Registry record
- Primary taxonomy
- 363LF0000X
363LF0000X
- Licence states on file
- ID
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2007-10-01
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho