Organization
TETON OBSTETRICS AND GYNECOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATIE DAVENPORT (BILLING)
(208) 520-2636
Entity
Organization
Contact information
Practice address
2001 S WOODRUFF AVE, SUITE 10, IDAHO FALLS, ID 83404-6374
(208) 523-2060
Mailing address
2001 S WOODRUFF AVE, SUITE 10, IDAHO FALLS, ID 83404-6374
(208) 523-2060
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
02/15/2016
Last updated
02/15/2016
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