Individual
DR. SHANE GARY MACHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1995 E 17TH ST, IDAHO FALLS, ID 83404-6493
(208) 522-7666
(208) 524-2821
Mailing address
1995 E 17TH ST, IDAHO FALLS, ID 83404-6493
(208) 522-7666
(208) 524-2821
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-0611
ID
Other
Enumeration date
08/03/2009
Last updated
12/28/2011
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