| Julian Debruynkops Md Pa | |
|
2065 E 17th St Suite C Idaho Falls ID 83404-8042 | |
| (208) 522-6106 | |
| Not Available |
| Full Name | Julian Debruynkops Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 2065 E 17th St, Idaho Falls, Idaho |
| Authorized Official Name and Position | Julian De Bruyn Kops (DIRECTOR) |
| Authorized Official Contact | 2085226106 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Julian Debruynkops Md Pa 2065 E 17th St Suite C Idaho Falls ID 83404-8042 Ph: (208) 522-6106 | Julian Debruynkops Md Pa 2065 E 17th St Suite C Idaho Falls ID 83404-8042 Ph: (208) 522-6106 |
| NPI Number | 1932417607 |
|---|---|
| Provider Enumeration Date | 09/16/2010 |
| Last Update Date | 11/19/2010 |
| Medicare PECOS PAC ID | 2668651043 |
|---|---|
| Medicare Enrollment ID | O20110201000595 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932417607 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | M3222 (Idaho) | Primary |
| Provider Name | Julian De Bruyn Kops |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922086552 PECOS PAC ID: 5193904571 Enrollment ID: I20110201000632 |
| Provider Name | Samantha De Bruyn Kops |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730744947 PECOS PAC ID: 1456685122 Enrollment ID: I20190628002896 |
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