Organization
FUNCTIONAL MEDICINE OF NEVADA PLLC
Active
Parent organization
FUNCTIONAL MEDICINE OF IDAHO PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FUNCTIONAL MEDICINE OF IDAHO PC
Authorized official
SAM WARREN (CEO)
(208) 385-7711
Entity
Organization
Contact information
Practice address
6490 S MCCARRAN BLVD STE 16, RENO, NV 89509-6165
(208) 385-7711
Mailing address
3858 N GARDEN CENTER WAY STE 100, BOISE, ID 83703-5008
(208) 385-7711
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
02/17/2021
Last updated
02/17/2021
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