Organization · NPI-2

Family & Functional Medicine Of Idaho PLLC

Family Medicine · Eagle, ID

NPI number1114352242
StatusActive
Last updated in NPPESSep 9, 2013

Details

NPI
1114352242
Entity type
Organization (NPI-2)
Legal business name
Family & Functional Medicine Of Idaho PLLC
Organization subpart
No
Enumeration date
Sep 9, 2013
Last updated
Sep 9, 2013

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine0-O370IDYes

Practice location

450 W State St
Suite 250
Eagle, ID 83616-7057

Phone 208-947-0925 · Fax 208-947-0926

Mailing address

450 W State St
Suite 250
Eagle, ID 83616-7057

Phone 208-947-0925 · Fax 208-947-0926

Authorized official

Angela L House
Physician / Owner
2089470925

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