Individual
ALAN JAKE POULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2375 E SUNNYSIDE RD, STE J, IDAHO FALLS, ID 83404-8280
(208) 522-7246
(208) 529-2620
Mailing address
2375 E SUNNYSIDE RD, STE J, IDAHO FALLS, ID 83404-8280
(208) 522-7246
(208) 529-2620
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2004-0463
NM
Other
Enumeration date
02/06/2007
Last updated
10/15/2014
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