| NPI | 1548892532 |
|---|---|
| Other Name | MOUNTAIN STATE DIABETES |
| Entity Type | Organization |
| Authorized Contact | DAVID NEAL PICKERING Owner 877-377-8427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| Enumeration Date | 2020-02-07 |
| Last Update Date | 2021-11-30 |