# GEM FAMILY MEDICINE LLC

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

## Provider details

- **NPI number:** 1720362775
- **Authorized official:** MS. TRACEY VERNALEE MARSON (OFFICE MANAGER)
- **Authorized official phone:** (208) 365-3455

## Contact information

- **Practice address:** 1108 SOUTH WASHINGTON AVE, EMMETT, ID 83617-3535
- **Practice address phone:** (208) 365-3455
- **Practice address fax:** (208) 365-3422
- **Mailing address:** 1108 SOUTH WASHINGTON AVE, EMMETT, ID 83617-3535
- **Mailing address phone:** (208) 365-3455
- **Mailing address fax:** (208) 365-3422

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | N-33941 | ID | — |
| 207Q00000X | Family Medicine Physician | NP-701A | ID | Yes |

## Other

- **Enumeration date:** 10/07/2011
- **Last updated:** 10/07/2011