MATTHEW L DIVIETRO

MERIDIAN, ID
NPI1427265867
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207RP1001X Internal Medicine, Pulmonary Disease
(Licence: ID  O 0727)
Additional Taxonomies207R00000X Internal Medicine
(Licence: ID  O 0727)
207RC0200X Internal Medicine, Critical Care Medicine
(Licence: ID  O 0727)
Enumeration Date2007-05-16
Last Update Date2022-08-24
Business Address
MATTHEW L DIVIETRO DO
2347 E GALA ST
MERIDIAN, ID 83642-4881
Phone number: 208-323-3767
Mailing Address
MATTHEW L DIVIETRO DO
190 E BANNOCK ST
BOISE, ID 83712-6241
Phone number: 208-381-2222