Individual
GREGORY T BOTKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6640 KANIKSU ST, BONNERS FERRY, ID 83805-7532
(208) 267-3141
Mailing address
6640 KANIKSU ST, BONNERS FERRY, ID 83805-7532
(208) 267-3141
(208) 267-0660
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-7205
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346341351
—
ID
01
—
CS-7048
IDAHO CONTROLLED SUBSTANC
ID
01
—
M-7205
STATE LICENSE
ID
Enumeration date
09/25/2006
Last updated
03/07/2023
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