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General NPI Number Information
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NPI Number | 1770017568
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Entity Type | Individual
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Provider Name | BRETT MCBRIDE DO
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Gender | Male
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 2325 CORONADO ST
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7407
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Country | US
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Telephone | 208-557-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 287 ROCK HOLLOW LN
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City | IDAHO FALLS
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State | ID
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Zip | 83401-6172
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Country | US
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Telephone |
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | O-1631
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License Number State | ID
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