| NPI | 1699805994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN MARIE DAUGHARTY FOWLER Md Owner 208-667-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M5531) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA573) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-08-22 |