# DOCTORS CLINIC OF ELMORE COUNTY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063578664
- **Authorized official:** DR. LAYNE D ROBERTS D.O. (PHYSICIAN)
- **Authorized official phone:** (208) 587-1500

## Contact information

- **Practice address:** 2000 AMERICAN LEGION BLVD, MOUNTAIN HOME, ID 83647-3138
- **Practice address phone:** (208) 587-1500
- **Practice address fax:** (208) 587-3180
- **Mailing address:** 2000 AMERICAN LEGION BLVD, MOUNTAIN HOME, ID 83647-3138
- **Mailing address phone:** (208) 587-1500
- **Mailing address fax:** (208) 587-3180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | O-91 | ID | Yes |
| 363A00000X | Physician Assistant | PA-265 | ID | — |

## Other

- **Enumeration date:** 12/28/2006
- **Last updated:** 02/25/2008