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General NPI Number Information
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NPI Number | 1043650633
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Entity Type | Individual
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Provider Name | PETER VOSS ABRAHAM D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 507 S FITNESS PL SUITE 110
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City | EAGLE
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State | ID
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Zip | 83616-6552
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Country | US
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Telephone | 208-947-0925
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Fax | 208-947-0926
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Provider Business Mailing Address
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Address Line | 507 S FITNESS PL SUITE 110
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City | EAGLE
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State | ID
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Zip | 83616-6552
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Country | US
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Telephone | 208-947-0925
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Fax | 208-947-0926
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7859
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | O-0988
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License Number State | ID
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