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Organization
HERITAGE PHYSICIAN AND RESOURCE GROUP LLC
Active
Organization
HERITAGE PHYSICIAN AND RESOURCE GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONNY RYAN FISHER (CEO)
(208) 238-0088
Entity
Organization
Contact information
Practice address
1009 W QUINN RD, POCATELLO, ID 83202-2425
(208) 238-0088
(208) 238-0055
Mailing address
1009 W QUINN RD, POCATELLO, ID 83202-2425
(208) 238-0088
(208) 238-0055
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
NULL
1041C0700X
Clinical Social Worker
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
03/26/2015
Last updated
08/15/2024
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