Organization
PEARL PRIMARY CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ZAKERY WARREN LCPC (OWNER/DIRECTOR)
(208) 346-7500
Entity
Organization
Contact information
Practice address
2705 E 17TH ST STE B, AMMON, ID 83406-6601
(208) 497-0566
(208) 346-7501
Mailing address
2705 E 17TH ST STE B, AMMON, ID 83406-6601
(208) 497-0566
(208) 346-7501
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1848
CITY OF AMMON BUSINESS LICENSE
ID
Enumeration date
09/11/2018
Last updated
09/11/2018
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