# PEARL PRIMARY CARE PLLC

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

## Provider details

- **NPI number:** 1720561103
- **Authorized official:** MR. ZAKERY WARREN LCPC (OWNER/DIRECTOR)
- **Authorized official phone:** (208) 346-7500

## Contact information

- **Practice address:** 2705 E 17TH ST STE B, AMMON, ID 83406-6601
- **Practice address phone:** (208) 497-0566
- **Practice address fax:** (208) 346-7501
- **Mailing address:** 2705 E 17TH ST STE B, AMMON, ID 83406-6601
- **Mailing address phone:** (208) 497-0566
- **Mailing address fax:** (208) 346-7501

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/11/2018
- **Last updated:** 09/11/2018