Organization
EXODUS PAIN CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL MARSH MD (MD/OWNER)
(208) 994-2907
Entity
Organization
Contact information
Practice address
987 S ALLANTE PL, BOISE, ID 83709-1612
(208) 947-7246
(208) 297-7772
Mailing address
987 S ALLANTE PL, BOISE, ID 83709-1612
(208) 947-7246
(208) 297-7772
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
M9452
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356377535
—
ID
Enumeration date
12/03/2014
Last updated
06/22/2023
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