# FAMILY PRACTICE RESIDENCY OF IDAHO, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Family Practice Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982632550
- **Authorized official:** TED EPPERLY M.D. (CHAIRMAN AND PROGRAM DIRECTOR)
- **Authorized official phone:** (208) 367-6042

## Contact information

- **Practice address:** 777 N RAYMOND ST, BOISE, ID 83704-9251
- **Practice address phone:** (208) 367-6030
- **Practice address fax:** (208) 367-6123
- **Mailing address:** 777 N RAYMOND ST, BOISE, ID 83704-9251
- **Mailing address phone:** (208) 367-6030
- **Mailing address fax:** (208) 367-6123

## Taxonomy

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

## Other

- **Enumeration date:** 06/30/2006
- **Last updated:** 01/30/2008