Organization
FAZZIO CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK J FAZZIO JR. MD (PRESIDENT / OWNER)
(208) 321-8600
Entity
Organization
Contact information
Practice address
7301 W EMERALD ST, STE 102, BOISE, ID 83704-8688
(208) 321-8600
(208) 321-8626
Mailing address
7301 W EMERALD ST, STE 102, BOISE, ID 83704-8688
(208) 321-8600
(208) 321-8626
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194831339
NPI
ID
01
—
8H914
BLUE CROSS
ID
Enumeration date
08/21/2006
Last updated
06/30/2010
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