| NPI | 1053387985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAM S GREGG Billing Clerk 208-773-0721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M3785) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 17473) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2020-08-22 |