Organization
SOUTHEAST IDAHO GASTROENTEROLOGY, PLLC
Active
Organization
SOUTHEAST IDAHO GASTROENTEROLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE J FERREL (PRACTICE MANAGER)
(208) 232-6616
Entity
Organization
Contact information
Practice address
1151 HOSPITAL WAY STE A, POCATELLO, ID 83201-5091
(208) 232-6616
(208) 232-6618
Mailing address
1151 HOSPITAL WAY STE A, POCATELLO, ID 83201-5091
(208) 232-6616
(208) 232-6618
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-629
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806196200
—
ID
Enumeration date
12/17/2007
Last updated
12/17/2007
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