| NPI | 1821364332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TED REA Owner 208-280-7541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: ID M6676) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2013-04-09 |