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1912046913
ALAN JAKE POULTER
IDAHO FALLS, ID
NPI
1912046913
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207L00000X Anesthesiology
(Licence: NM 2004-0463)
Enumeration Date
2007-02-06
Last Update Date
2014-10-15
Business Address
-- ALAN JAKE POULTER MD
2375 E SUNNYSIDE RD STE J
IDAHO FALLS, ID 83404-8280
Phone number: 208-522-7246
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Mailing Address
-- ALAN JAKE POULTER MD
2375 E SUNNYSIDE RD STE J
IDAHO FALLS, ID 83404-8280
Phone number: 208-522-7246
Copy
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