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General NPI Number Information
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NPI Number | 1558968750
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Entity Type | Organization
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Legal Business Name | FAMILY FOOT AND ANKLE OF IDAHO L L C
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 3597 E MONARCH SKY LANE SUIT 240 PMB 2358
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City | MERIDIAN
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State | ID
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Zip | 83646-1055
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Country | US
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Telephone | 208-996-3519
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Fax | 208-906-2195
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Provider Business Mailing Address
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Address Line | 3597 E MONARCH SKY LANE SUIT 240 PMB 2358
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City | MERIDIAN
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State | ID
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Zip | 83646-1055
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Country | US
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Telephone | 208-996-3519
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Fax | 208-906-2195
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREW LOWRY
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Credential | DPM
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Telephone | 208-996-3519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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