Individual
MR. BRENT M. FAURE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
13279 N MOONGLOW LN, POCATELLO, ID 83202-5122
(208) 237-2971
Mailing address
13279 MOONGLOW, POCATELLO, ID 83202-5122
(208) 237-2971
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
008
ID
Other
Enumeration date
07/12/2006
Last updated
07/08/2007
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