MATTHEW J FACKRELL DO
Individual Provider (NPI-1)
Active
Family Medicine
Provider Information
- NPI Number
1215968045- Provider Type
- Individual Provider (NPI-1)
- Credentials
- DO
- Status
- Active
Contact & Location
- Address
- 1441 PARKWAY DR, BLACKFOOT, ID, 832211667
- Phone
- (208) 785-2600
- Fax
- (208) 785-8185
Specialties & Taxonomies
Family Medicine
License: WA #OP61556804
Family Medicine
License: OR #DO221842
Family Medicine
License: PA #OS024313
Family Medicine
Primary License: CO #DR.0073268