WALLACE BAKERS MID-LEVEL GROUP

IDAHO FALLS, ID
NPI1639370810
Entity TypeOrganization
Authorized ContactWALLACE COLEMAN BAKER
CEO
208-524-6633
Organization Subpart ?No
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: ID  M6919)
Enumeration Date2007-05-29
Last Update Date2020-08-22
Business Address
WALLACE BAKERS MID-LEVEL GROUP
1880 JOHN ADAMS PKWY
IDAHO FALLS, ID 83401-4315
Phone number: 208-524-6633
Mailing Address
WALLACE BAKERS MID-LEVEL GROUP
1880 JOHN ADAMS PKWY
IDAHO FALLS, ID 83401-4315
Phone number: 208-524-6633