Organization
HERITAGE PHYSICIAN AND RESOURCE GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONNY RYAN FISHER (CEO)
(208) 238-0088
Entity
Organization
Contact information
Practice address
1009 W QUINN RD, POCATELLO, ID 83202-2425
(208) 238-0088
(208) 238-0055
Mailing address
1009 W QUINN RD, POCATELLO, ID 83202-2425
(208) 238-0088
(208) 238-0055
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
03/26/2015
Last updated
08/15/2024
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