NPI 1124197702

Specialized Family Medicine

Organisation Family Medicine Physician Pocatello, ID

Practice location

Address: 151 N 4th Ave Suite B, Pocatello, ID 83201-6300
Phone: (208) 369-7147
Fax: (208) 416-6522

Authorised official

Name: Jordan L Bailey
Title: Physician Owner
Phone: (208) 269-7147

Registered specialties

Family Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X

Other Family Medicine providers in Idaho →

Registry record

NPI: 1124197702
Entity type: Organization
NPI issued: 7 Nov 2006
Record last updated: 21 Jul 2022

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.