# MMMEDICAL GROUP LLC.

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

## Provider details

- **NPI number:** 1548890460
- **Authorized official:** RANDY EVARO (PRESIDENT)
- **Authorized official phone:** (208) 333-0000

## Contact information

- **Practice address:** 801 N STILSON RD STE 300, BOISE, ID 83703-5145
- **Practice address phone:** (208) 332-4540
- **Mailing address:** PO BOX 5328, BOISE, ID 83705-0328
- **Mailing address phone:** (208) 333-0000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 01/20/2020
- **Last updated:** 09/23/2020