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Organization
SPECIALIZED FAMILY MEDICINE
Active
Organization
SPECIALIZED FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN L BAILEY MD (PHYSICIAN OWNER)
(208) 269-7147
Entity
Organization
Contact information
Practice address
151 N 4TH AVE, SUITE B, POCATELLO, ID 83201-6300
(208) 369-7147
(208) 416-6522
Mailing address
151 N 4TH AVE, SUITE B, POCATELLO, ID 83201-6300
(208) 369-7147
(208) 416-6522
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
ID
Other
Enumeration date
11/07/2006
Last updated
07/21/2022
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