Individual
DR. HEATHER FOWLER CUMBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2434
(208) 750-7445
Mailing address
2280 E 25TH ST, IDAHO FALLS, ID 83404-7542
(208) 227-2100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
149697
NC
2084P0800X
Psychiatry Physician
M-13872
ID
2084P0800X
Psychiatry Physician
Primary
ME121892
FL
Other
Enumeration date
08/10/2008
Last updated
09/30/2020
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