Organization
PETRIE WHITE FAMILY MEDICINE OF IDAHO
Active
Other names
Emmett Family Medicine and Direct Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN EARL WHITE CRNA (CLINIC ADMINISTRATOR)
(208) 365-7131
Entity
Organization
Contact information
Practice address
2001 E QUAIL RUN RD, EMMETT, ID 83617-5059
(208) 365-7131
(208) 365-4464
Mailing address
2001 E QUAIL RUN RD, EMMETT, ID 83617-5059
(208) 365-7131
(208) 365-4464
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M7802
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805196400
—
ID
Enumeration date
09/18/2015
Last updated
01/12/2016
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