Organization
BOISE ANESTHESIA, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW BRYAN FOWLER MD (PRESIDENT)
(208) 367-6416
Entity
Organization
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1352
(208) 367-6416
Mailing address
PO BOX 3750, SALT LAKE CITY, UT 84110-3750
(800) 945-9877
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
N/A
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M0026442
—
ID
Enumeration date
05/09/2006
Last updated
07/18/2018
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