Organization
IDAHO FALLS PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RON WADE PORTER MD (OWNER)
(208) 522-4600
Entity
Organization
Contact information
Practice address
3067 EAGLE DR, AMMON, ID 83406-1273
(208) 522-4600
(208) 552-7521
Mailing address
3067 EAGLE DR, AMMON, ID 83406-1273
(208) 522-4600
(208) 552-7521
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
M7271
ID
Other
Enumeration date
03/26/2007
Last updated
12/05/2024
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