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

Tony C Roisum MD PA

Organization Family Medicine Physician · NPI 1124115944

Tony C Roisum MD PA provides Family Medicine Physician services 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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