| NPI | 1275733370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE-KIM WAITE Provider 208-343-1702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: ID M-7308) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2019-07-19 |