Organization
DIGESTIVE HEALTH CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK A MALLORY M.D. (MANAGER)
(208) 489-1900
Entity
Organization
Contact information
Practice address
6259 W EMERALD ST, BOISE, ID 83704-8731
(208) 489-1900
(208) 375-5286
Mailing address
6259 W EMERALD ST, BOISE, ID 83704-8731
(208) 489-1900
(208) 375-5286
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807631700
—
ID
Enumeration date
08/23/2006
Last updated
07/24/2020
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