Individual
ANNE L BROADWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2730 CHANNING WAY, IDAHO FALLS, ID 83404-5049
(208) 542-7100
Mailing address
2730 CHANNING WAY, IDAHO FALLS, ID 83404-5049
(208) 542-7100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101255431
VA
207Q00000X
Family Medicine Physician
Primary
M-11017
ID
207Q00000X
Family Medicine Physician
MED-PHYS-LIC-34391
MT
Other
Enumeration date
11/13/2006
Last updated
04/03/2019
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