MATTHEW J FACKRELL

BLACKFOOT, ID
NPI1215968045
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: CO  DR.0073268)
Additional Taxonomies207Q00000X Family Medicine
(Licence: WA  OP61556804)
207Q00000X Family Medicine
(Licence: OR  DO221842)
207Q00000X Family Medicine
(Licence: PA  OS024313)
Enumeration Date2006-07-06
Last Update Date2024-10-22
Business Address
MATTHEW J FACKRELL DO
1441 PARKWAY DR
BLACKFOOT, ID 83221-1667
Phone number: 208-785-2600
Mailing Address
MATTHEW J FACKRELL DO
1441 PARKWAY DR
BLACKFOOT, ID 83221-1667
Phone number: 208-785-2600