NPI 1053597237
Mountain Medical Physician Specialists of Idaho PC
Practice location
- Address
- 1501 Hiland Ave, Burley, ID 83318-2682
- Phone
- (801) 284-1755
- Fax
- (801) 262-3897
- Mailing address
- 5444 Green St, Murray, UT 84123-5632
Authorised official
- Name
- Clark a Davis
- Title
- Ceo
- Phone
- (801) 284-1705
Registered specialties
Diagnostic Radiology Physician
Primary
Registry record
- NPI
- 1053597237
- Entity type
- Organization
- NPI issued
- 17 Jan 2008
- Record last updated
- 12 Nov 2008
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.