# ISU FAMILY MEDICINE

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

## Provider details

- **NPI number:** 1750644225
- **Authorized official:** DR. JONATHAN CREE M.D. (PROGRAM DIRECTOR)
- **Authorized official phone:** (208) 282-3253

## Contact information

- **Practice address:** 465 MEMORIAL DR, POCATELLO, ID 83201-4008
- **Practice address phone:** (208) 282-4700
- **Practice address fax:** (208) 282-4818
- **Mailing address:** 465 MEMORIAL DR, POCATELLO, ID 83201-4008
- **Mailing address phone:** (208) 282-4700
- **Mailing address fax:** (208) 282-4818

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MRM-1245 | ID | Yes |

## Other

- **Enumeration date:** 06/20/2012
- **Last updated:** 06/20/2012