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Individual

MATTHEW JAMES WOLTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-5015
(208) 381-1873
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8752

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MRO1909
ID
207R00000X
Internal Medicine Physician
Primary
O-1866
ID

Other

Enumeration date
06/18/2018
Last updated
09/09/2024
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