Individual
MR. ISMAEL GRACHICO II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
775 POLE LINE RD W STE 212, TWIN FALLS, ID 83301-5820
(208) 814-8400
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M-16804
ID
208600000X
Surgery Physician
MD250761
OR
Other
Enumeration date
03/20/2016
Last updated
10/31/2022
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