MOUNTAIN CREST FOOT AND ANKLE PA

IDAHO FALLS, ID
NPI1932191996
Entity TypeOrganization
Authorized ContactTIMOTHY ROGER BLACK
Owner/Physician
208-528-8700
Organization Subpart ?No
Primary Taxonomy213E00000X Podiatrist
(Licence: ID  P-169)
Enumeration Date2005-08-16
Last Update Date2010-12-06
Business Address
MOUNTAIN CREST FOOT AND ANKLE PA
3652 WASHINGTON PKWY
IDAHO FALLS, ID 83404-7573
Phone number: 208-528-8700
Mailing Address
MOUNTAIN CREST FOOT AND ANKLE PA
3652 WASHINGTON PKWY
IDAHO FALLS, ID 83404-7573
Phone number: 208-528-8700
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