Healthcare Provider Details

I. General information

NPI: 1922152537
Provider Name (Legal Business Name): BONNERS FERRY FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6488 CHINOOK ST
BONNERS FERRY ID
83805-9517
US

IV. Provider business mailing address

PO BOX 208
BONNERS FERRY ID
83805-0208
US

V. Phone/Fax

Practice location:
  • Phone: 208-946-0572
  • Fax:
Mailing address:
  • Phone: 208-267-1788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM8544
License Number StateID

VIII. Authorized Official

Name: DR. TROY GEYMAN
Title or Position: MANAGER
Credential: M.D.
Phone: 208-267-1788