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General NPI Number Information
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NPI Number | 1174699722
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Entity Type | Organization
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Legal Business Name | SEASONS MEDICAL, PLLC
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 37 S 2ND E
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City | REXBURG
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State | ID
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Zip | 83440
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Country | US
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Telephone | 208-356-0234
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Fax | 208-656-0365
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Provider Business Mailing Address
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Address Line | 37 S 2ND E
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City | REXBURG
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State | ID
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Zip | 83440-1906
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Country | US
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Telephone | 208-356-0234
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Fax | 208-656-0365
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GEOFF SCHWIERMANN
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Credential |
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Telephone | 208-356-0234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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