Organization
EAGLE INTERNAL MEDICINE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL A PATMAS M.D. (PRESIDENT)
(208) 938-0090
Entity
Organization
Contact information
Practice address
1025 S BRIDGE WAY PL, SUITE 100, EAGLE, ID 83616-6834
(208) 938-0090
Mailing address
1025 S. BRIDGEWAY PL., SUITE 100, EAGLE, ID 83616
(208) 938-0090
(208) 938-0918
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M10058
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C55688
UPIN
—
Enumeration date
06/30/2009
Last updated
06/30/2009
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