Organization
NUTRITIONAL MEDICINE OF IDAHO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW R MACHA M.D. (OWNER)
(208) 343-3883
Entity
Organization
Contact information
Practice address
1520 W STATE ST, SUITE 220, BOISE, ID 83702-4085
(208) 343-3883
(208) 287-2010
Mailing address
1520 W STATE ST, SUITE 220, BOISE, ID 83702-4085
(208) 343-3883
(208) 287-2010
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
D043
ID
Other
Enumeration date
02/25/2008
Last updated
02/25/2008
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