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Organization

MOUNTAIN VIEW FAMILY MEDICINE, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BRADLEY MARK BURTON M.D. (PRESIDENT)
(208) 232-1132
Entity
Organization

Contact information

Practice address
2006 BIRDIE THOMPSON DR, POCATELLO, ID 83201-2768
(208) 232-1132
(208) 232-1134
Mailing address
2006 BIRDIE THOMPSON DR, POCATELLO, ID 83201-2768
(208) 232-1132
(208) 232-1134

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1373873
MEDICARE
ID
05
86428200
ID
Enumeration date
11/15/2006
Last updated
07/21/2022
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