| NPI | 1780867457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBIE J FERREL Practice Manager 208-232-6616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-629) |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2007-12-17 |