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Organization
IDAHO PEDIATRIC GASTROENTEROLOGY PA
Active
Organization
IDAHO PEDIATRIC GASTROENTEROLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY R THOMPSON MD (PRESIDENT)
(208) 381-7310
Entity
Organization
Contact information
Practice address
100 E IDAHO ST, SUITE 316, BOISE, ID 83712-6223
(208) 381-7310
Mailing address
100 E IDAHO ST, SUITE 316, BOISE, ID 83712-6223
(208) 381-7310
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M7673
ID
Other
Enumeration date
09/26/2007
Last updated
09/26/2007
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