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General NPI Number Information
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NPI Number | 1043779127
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Entity Type | Organization
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Legal Business Name | TETON SURGICAL SPECIALTIES PLLC
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 1542 ELK CREEK DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8322
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Country | US
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Telephone | 844-919-4263
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Fax | 833-513-0980
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Provider Business Mailing Address
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Address Line | 1542 ELK CREEK DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8322
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Country | US
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Telephone | 844-919-4263
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Fax | 833-513-0980
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Authorized Official
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Title or Position | OWNER / MD
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Name | BRUCE JAMES WATKINS
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Credential |
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Telephone | 844-919-4263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) Physician
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License Number |
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License Number State |
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