SOUTHEAST IDAHO GASTROENTEROLOGY, PLLC
Organization (NPI-2)
Active
Physician Assistant, Medical
Provider Information
- NPI Number
1780867457- Provider Type
- Organization / Facility (NPI-2)
- Status
- Active
Contact & Location
- Address
- 1151 HOSPITAL WAY STE A, POCATELLO, ID, 832015091
- Phone
- (208) 232-6616
- Fax
- (208) 232-6618
Specialties & Taxonomies
Physician Assistant, Medical
Primary License: ID #PA-629