Organization
IDAHO MODERN MEDICINE - PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL A ANDERSON DO (PHYSICIAN / OWNER)
(208) 648-4789
Entity
Organization
Contact information
Practice address
1000 POCATELLO CREEK RD STE E10, POCATELLO, ID 83201-2953
(208) 317-5371
Mailing address
1000 POCATELLO CREEK RD STE E10, POCATELLO, ID 83201-2953
(208) 648-4789
(208) 648-4790
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
01/31/2020
Last updated
02/05/2024
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