Family & Functional Medicine of Idaho Pllc

NPI #1114352242 in Eagle, Idaho

Provider Information

NPI Number: 1114352242
Entity Type: Organization
Organization Name: Family & Functional Medicine of Idaho Pllc
Primary Specialty: Family Medicine
Enumeration Date: Sep 9, 2013
Last Updated: Sep 9, 2013

Practice Location

Address: 450 W STATE ST
Address 2: SUITE 250
City: Eagle
State: Idaho
ZIP Code: 83616-7057
Phone: (208) 947-0925

Authorized Official

Name: ANGELA L HOUSE, DO
Title: PHYSICIAN / OWNER
Phone: (208) 947-0925

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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