Organization
ROCKY MOUNTAIN EMERGENCY PHYSICIANS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL SCOTT FOWLER MD (PRESIDENT)
(208) 239-1111
Entity
Organization
Contact information
Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201
(480) 421-9799
(480) 421-9899
Mailing address
PO BOX 15070, SCOTTSDALE, AZ 85267-5070
(480) 421-9700
(480) 421-9899
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
M4363
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8N801
BLUE CROSS
ID
01
—
M4363
LICNESE NUMBER
ID
Enumeration date
01/19/2009
Last updated
05/11/2011
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