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Individual

MARA ADDITON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
777 HOSPITAL WAY STE 201, POCATELLO, ID 83201-5175
(208) 239-2620
Mailing address
PO BOX 4168, POCATELLO, ID 83205-4168
(208) 239-2065

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M-14265
ID
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
04/15/2013
Last updated
09/13/2018
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