Fackrell, Matthew J

Fackrell, Matthew J is an individual health care provider with primary practice located at 1441 Parkway Dr , Blackfoot ID 83221-1667. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Fackrell, Matthew J can be contacted via phone (208) 785-2600.

Contact Information

Primary practice address
1441 Parkway Dr Blackfoot ID 83221-1667
Phone: (208) 785-2600
Fax: (208) 785-8185
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X DR.0073268 Colorado
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X OP61556804 Washington
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 02002954A Indiana

Profile Details

NPI number 1215968045
LBN Legal business name Fackrell, Matthew J
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2006
Last updated Jul 3rd, 2024 - about 2 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215968045 NPPES
Idaho MEDICAID 807815500
Idaho Other 1374716

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