Functional and Integrative Medicine of Idaho PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M4631 Issued in ID

Legal business name

FUNCTIONAL AND INTEGRATIVE MEDICINE OF IDAHO PA

Practice address

3858 N Garden Center Way
Suite 100
Boise, ID 83703-5008

Phone

(208) 385-7711

Fax

(208) 385-0346

NPI assigned

Nov 15, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gail M. Eberharter, M.D.

Title

President

Phone

(208) 863-1399

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422489600000",
    "number": "1740524701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2905 W JORDAN ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837022134",
            "telephone_number": "208-863-1399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3858 N GARDEN CENTER WAY",
            "address_2": "SUITE 100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837035008",
            "telephone_number": "208-385-7711",
            "fax_number": "208-385-0346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL AND INTEGRATIVE MEDICINE OF IDAHO PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-15",
        "last_updated": "2015-01-29",
        "status": "A",
        "authorized_official_last_name": "EBERHARTER",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-863-1399",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M4631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald F Fullmer, M.D.
• Teri Fullmer, ABO
• Barbara Nixon Fultz, COMS
• Darby Fulwider
• Vicki Funaiole
• Functional Medicine of Idaho PC
• Functional Physical Therapy Center
• Mon-Yee Fung
• Heidi Funk
• Nicole Marie Funk, PA-C

• Family Medicine Physician in Boise, ID
• Providers in Boise, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.