| Roger S. Brunt M.d. P.a. | |
|
1995 E 17th St Idaho Falls ID 83404-6493 | |
| (208) 201-3737 | |
| Not Available |
| Full Name | Roger S. Brunt M.d. P.a. |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1995 E 17th St, Idaho Falls, Idaho |
| Authorized Official Name and Position | Roger Stevenson Brunt (PRESIDENT) |
| Authorized Official Contact | 2082013737 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Roger S. Brunt M.d. P.a. 1995 E 17th St Idaho Falls ID 83404-6493 Ph: (208) 201-3737 | Roger S. Brunt M.d. P.a. 1995 E 17th St Idaho Falls ID 83404-6493 Ph: (208) 201-3737 |
| NPI Number | 1922287226 |
|---|---|
| Provider Enumeration Date | 11/02/2007 |
| Last Update Date | 11/02/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922287226 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | M3281 (Idaho) | Primary |
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