| Family & Functional Medicine Of Idaho Pllc | |
|
450 W State St Suite 250 Eagle ID 83616-7057 | |
| (208) 947-0925 | |
| (208) 947-0926 |
| Full Name | Family & Functional Medicine Of Idaho Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 450 W State St, Eagle, Idaho |
| Authorized Official Name and Position | Angela L House (PHYSICIAN / OWNER) |
| Authorized Official Contact | 2089470925 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family & Functional Medicine Of Idaho Pllc 450 W State St Suite 250 Eagle ID 83616-7057 Ph: (208) 947-0925 | Family & Functional Medicine Of Idaho Pllc 450 W State St Suite 250 Eagle ID 83616-7057 Ph: (208) 947-0925 |
| NPI Number | 1114352242 |
|---|---|
| Provider Enumeration Date | 09/09/2013 |
| Last Update Date | 09/09/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114352242 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0-O370 (Idaho) | Primary |
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