Organization
PREMIER EMERGENCY PHYSICIANS OF IDAHO MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH GATEWOOD (ENROLLMENT)
(800) 527-2145
Entity
Organization
Contact information
Practice address
1512 12TH AVE RD, NAMPA, ID 83686-6008
(208) 463-5100
Mailing address
3916 STATE ST, SUITE 300, SANTA BARBARA, CA 93105-5602
(805) 563-3011
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
05/08/2006
Last updated
03/24/2008
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