# GEM STATE ENT, PLLC

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

## Provider details

- **NPI number:** 1215715669
- **Authorized official:** BROOKE FREIDENBERGER (MEDICAL CODER)
- **Authorized official phone:** (208) 858-6008

## Contact information

- **Practice address:** 2102 CANYON PLAZA DR, TWIN FALLS, ID 83301-4513
- **Practice address phone:** (208) 352-7555
- **Practice address fax:** (208) 352-7333
- **Mailing address:** 2114 VILLAGE PARK AVE \# 200, TWIN FALLS, ID 83301-4172
- **Mailing address phone:** (208) 804-1717
- **Mailing address fax:** (208) 804-1707

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/18/2023
- **Last updated:** 04/08/2025