Individual
GLENN C BOTHWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
703 S AMERICANA BLVD, BOISE, ID 83702-5099
(208) 706-7500
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
M3165
ID
Other
Enumeration date
05/19/2006
Last updated
02/16/2011
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