IndividualActive
Blake Niederhauser, MD
NPI 1578726683 · Diagnostic Radiology Physician · Boise, ID
Provider details
- NPI number
- 1578726683
- Entity type
- Individual
- Primary specialty
- Diagnostic Radiology PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- 104451 (MN)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
190 E Bannock St
Boise, ID 83712-6241
Phone: (208) 381-2094
Fax: (208) 381-1791
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 1108
Corvallis, OR 97339-1108
Registry dates
- Enumerated
- 2008-07-08
- Last updated
- 2018-01-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.