Organization
BOISE ANESTHESIA, P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW BRYAN FOWLER MD (PRESIDENT)
(208) 367-6416
Entity
Organization
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1352
(208) 367-6416
Mailing address
PO BOX 3750, SALT LAKE CITY, UT 84110-3750
(800) 945-9877
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
N/A
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M0026448
—
ID
Enumeration date
05/04/2006
Last updated
01/14/2022
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