Individual
MATTHEW HALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1232 RIGBY RD, BANCROFT, ID 83217
(208) 251-3800
Mailing address
PO BOX 119, BANCROFT, ID 83217-0119
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
O-1063
ID
Other
Enumeration date
06/25/2015
Last updated
06/25/2018
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