Organization
BRYAN C POGUE MD
Active
Other names
Selah Medical Center, PA
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KELLI M SIZEMORE CMPE (ADMINISTRATOR)
(208) 377-5055
Entity
Organization
Contact information
Practice address
6565 W EMERALD ST, BOISE, ID 83704-8737
(208) 377-5055
(208) 377-5335
Mailing address
6565 W EMERALD ST, BOISE, ID 83704-8737
(208) 377-5055
(208) 377-5335
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M5125
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002789800
—
ID
Enumeration date
06/16/2005
Last updated
04/05/2016
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