Organization
POCATELLO PODIATRY ASSOCIATES PA
Active
Other names
Ambulatory Foot and Ankle Clinic, Ambulatory Foot and Ankle Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KOREE GODFREY (CREDENTIALING)
(208) 233-4355
Entity
Organization
Contact information
Practice address
1555 E CLARK ST, POCATELLO, ID 83201-4133
(208) 233-4355
(208) 233-7198
Mailing address
1555 E CLARK ST, POCATELLO, ID 83201-4133
(208) 233-4355
(208) 233-7198
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
P-82
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004400900
—
ID
Enumeration date
10/02/2007
Last updated
03/18/2021
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