Individual
LORE BETH WOOTTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
683 E 3RD ST, WEISER, ID 83672-2248
(208) 549-0211
(208) 549-0104
Mailing address
PO BOX 871, WEISER, ID 83672-0871
(208) 549-0211
(208) 549-0104
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-7162
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804102100
—
ID
Enumeration date
10/04/2006
Last updated
07/15/2008
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