Organization
EAGLE FAMILY MEDICINE P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAWN CHRISTIAN NOWIERSKI MD (OWNER)
(208) 939-3197
Entity
Organization
Contact information
Practice address
100 COTTONWOOD CT, SUITE 100, EAGLE, ID 83616-6576
(208) 939-3197
(208) 939-3263
Mailing address
100 COTTONWOOD CT, SUITE 100, EAGLE, ID 83616-6576
(208) 939-3197
(208) 939-3263
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-7050
ID
Other
Enumeration date
09/20/2006
Last updated
01/05/2015
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