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General NPI Number Information
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NPI Number | 1588863591
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Entity Type | Organization
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Legal Business Name | DOCTORS CLINIC PA
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 590 GIFFORD AVE
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City | AMERICAN FALLS
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State | ID
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Zip | 83211-1314
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Country | US
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Telephone | 208-226-5147
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Fax | 208-226-7002
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Provider Business Mailing Address
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Address Line | 590 GIFFORD AVE
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City | AMERICAN FALLS
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State | ID
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Zip | 83211-1314
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Country | US
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Telephone | 208-226-5147
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Fax | 208-226-7002
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Authorized Official
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Title or Position | MD
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Name | DR. DEAN L WILLIAMS
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Credential | MD
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Telephone | 208-226-5147
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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 | M3687
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License Number State | ID
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