Organization
POCATELLO PULMONARY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARY V JACKSON M.D. (PRESIDENT)
(208) 233-5864
Entity
Organization
Contact information
Practice address
500 S 11TH AVE, SUITE 305, POCATELLO, ID 83201-4835
(208) 233-5864
Mailing address
500 S 11TH AVE, SUITE 305, POCATELLO, ID 83201-4835
(208) 233-5864
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
M5647
ID
Other
Enumeration date
08/10/2006
Last updated
08/22/2020
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