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Organization
MMMEDICAL GROUP LLC.
Active
Organization
MMMEDICAL GROUP LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY EVARO (PRESIDENT)
(208) 333-0000
Entity
Organization
Contact information
Practice address
801 N STILSON RD STE 300, BOISE, ID 83703-5145
(208) 332-4540
Mailing address
PO BOX 5328, BOISE, ID 83705-0328
(208) 333-0000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/20/2020
Last updated
09/23/2020
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