Organization
MOUNTAIN STATES DIABETES RELIEF, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATIE DAVENPORT (PARTNER)
(208) 520-2636
Entity
Organization
Contact information
Practice address
4573 E MAJESTIC, IDAHO FALLS, ID 83406
(208) 520-2636
Mailing address
4573 E MAJESTIC, IDAHO FALLS, ID 83406
(208) 520-2636
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
Other
Enumeration date
04/12/2019
Last updated
04/12/2019
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