Organization
ROGER S. BRUNT M.D. P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER STEVENSON BRUNT M.D. (PRESIDENT)
(208) 201-3737
Entity
Organization
Contact information
Practice address
1995 E 17TH ST, IDAHO FALLS, ID 83404-6493
(208) 201-3737
Mailing address
1995 E 17TH ST, IDAHO FALLS, ID 83404-6493
(208) 201-3737
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
M3281
ID
Other
Enumeration date
11/02/2007
Last updated
11/02/2007
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