| NPI | 1144783499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE DAVENPORT Partner 208-520-2636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2019-04-12 |