Individual
DR. JOHN M FORNAROTTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
246 N 18TH AVE, POCATELLO, ID 83201-3356
(208) 234-4100
(208) 234-4192
Mailing address
246 N 18TH AVE, POCATELLO, ID 83201-3356
(208) 234-4100
(208) 234-4192
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M6417
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002738900
—
ID
Enumeration date
09/13/2005
Last updated
11/21/2008
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