Individual
DR. GORDON SCOTT BONTRAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
43 N 1ST E, PRESTON, ID 83263-1325
(208) 648-4771
(208) 744-0140
Mailing address
43 N 1ST E, PRESTON, ID 83263-1325
(208) 648-4771
(208) 744-0140
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MRM-1734
ID
363A00000X
Physician Assistant
2119
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15285357
—
TN
05
—
1780919829
—
VA
01
—
MRM-1734
IDAHO BOARD OF MEDICINE - RESIDENCY
ID
01
—
P01478459
RAIDROAD MEDICARE
TN
01
—
PA-2119
IDAHO BOARD OF MEDICINE - PA
ID
Enumeration date
10/07/2009
Last updated
01/29/2025
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