Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tony C Roisum MD PA

Organization Family Medicine Physician · NPI 1124115944

Tony C Roisum MD PA is a Family Medicine Physician in Idaho Falls, Idaho. Licensed in Idaho. Registered with an NPI since 2006.

Licensed in
ID
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3360 Washington Pkwy Ste 1
Idaho Falls, ID 83404-8333
Phone: (208) 524-3416
Fax: (208) 524-3138
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence M7389 (ID)
Sports Medicine (Family Medicine) Physician Taxonomy 207QS0010X · Licence M7389 (ID)

Record details

NPI number1124115944
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jacqueline Kelsey — Office Manager · (208) 524-3416
Other names Idaho Falls Family & Sports Medicine
NPI enumeratedOctober 5, 2006
Last updated in NPPESJanuary 16, 2026
Certification dateJanuary 16, 2026
Mailing address3360 Washington Pkwy Ste 1, Idaho Falls, ID 83404-7592

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