Individual
MR. GREG C BOETTCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
267 N CANYON DR, GOODING, ID 83330
(208) 934-4446
(208) 934-4442
Mailing address
267 N CANYON DR, GOODING, ID 83330-5500
(208) 934-4446
(208) 934-4442
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0237
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010141448
BLUE SHIELD
ID
05
—
805804000
—
ID
01
—
S4117
BLUE CROSS
—
Enumeration date
07/08/2006
Last updated
07/10/2018
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