Individual
JOHN CHARLES FOGG II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 473-0807
Mailing address
7080 W AMBLESIDE DR, BOISE, ID 83709-4901
(208) 473-0807
Taxonomy
Speciality
Code
Description
License number
State
163WG0100X
Gastroenterology Registered Nurse
Primary
31358
ID
Other
Enumeration date
05/20/2020
Last updated
05/20/2020
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