Organization
PRESTON FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON SCOTT BONTRAGER MD (OWNER)
(423) 215-6465
Entity
Organization
Contact information
Practice address
43 N 1ST E, PRESTON, ID 83263-1325
(423) 215-6465
Mailing address
43 N 1ST E, PRESTON, ID 83263-1325
(423) 215-6465
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780919829
—
ID
Enumeration date
12/07/2022
Last updated
03/01/2023
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