institution
Teton Plastic Surgery
Plastic and Reconstructive Surgery Physician in Idaho Falls, Idaho
NPI 1154549616

Teton Plastic Surgery is a Plastic and Reconstructive Surgery Physician based in Idaho Falls, ID and is specialized in Plastic and Reconstructive Surgery. Teton Plastic Surgery practices in Idaho Falls, ID. The NPI Number for Teton Plastic Surgery is 1154549616 and holds a License No. M-8270 (Idaho).

The current practice location address for Teton Plastic Surgery is 2860 Channing Way, Idaho Falls, ID and can be reached out via phone at 208-552-1406 and via fax at 208-552-1416. You can also correspond with Teton Plastic Surgery through the mailing address at PO BOX 1769, IDAHO FALLS, ID - 83403-1769 (mailing address contact number: 208-552-1406).

Location: 2860 Channing Way, Idaho Falls, ID, 83403-1769
institution
Provider Profile Details
NPI Number
1154549616
Provider Name
Teton Plastic Surgery
Credential
Provider Entity Type
Organization
Address
2860 Channing Way, Idaho Falls, ID, 83403-1769
Phone Number
208-552-1406
Fax Number
208-552-1416
Provider Enumeration Date
04/23/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
M-8270 01 ID ID MEDICAL LICENSE
5959620-1205 01 UT UT MEDICAL LICENSE
5959620-8905 01 UT UT ST BOARD OF PHARMACY
6687A 01 WY WY MEDICAL LICENSE
CS9201 01 ID ID ST BOARD OF PHARMACY
58MKM02 01 WY WY ST BOARD OF PHARMACY
04232007480947 01 ID DR.MOORE NPI TRCKNG#
institution
Provider Business Practice Location Address Details
Address
2860 Channing Way
City
State
Zip
83404-7531
Phone Number
208-552-1406
Fax Number
208-552-1416
person
Provider Business Mailing Address Details
Address
Po Box 1769
City
State
Zip
83403-1769
Phone Number
208-552-1406
Fax Number
208-552-1416
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Surgery
Speciality
Plastic and Reconstructive Surgery
Taxonomy
License No.
M-8270 (Idaho)
Definition
A surgeon who specializes in plastic and reconstructive surgery.
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