# FUNCTIONAL AND INTEGRATIVE MEDICINE OF IDAHO PA

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

## Provider details

- **NPI number:** 1740524701
- **Authorized official:** DR. GAIL M. EBERHARTER M.D. (PRESIDENT)
- **Authorized official phone:** (208) 863-1399

## Contact information

- **Practice address:** 3858 N GARDEN CENTER WAY, SUITE 100, BOISE, ID 83703-5008
- **Practice address phone:** (208) 385-7711
- **Practice address fax:** (208) 385-0346
- **Mailing address:** 2905 W JORDAN ST, BOISE, ID 83702-2134
- **Mailing address phone:** (208) 863-1399

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | M4631 | ID | Yes |

## Other

- **Enumeration date:** 11/15/2012
- **Last updated:** 01/29/2015