| NPI | 1720204738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE L COWGILL Credentialing COO Rdinator 208-381-4137 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2008-04-09 |