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BRIAN W GOLTRY
190 E BANNOCK ST BOISE ID 837126241
BRIAN W GOLTRY is physician registered in the Centers for Medicare & Medicaid Services (CMS). The National Provider Identifier (NPI) of the National Plan and Provider Enumeration System (NPPES) is 1578591210. The unique individual professional ID assigned by Provider Enrollment, Chain, and Ownership System (PECOS) is 2668469925. The primary specialty is PULMONARY DISEASE. The organization is ST LUKES CLINIC-TREASURE VALLEY LLC. The address is 190 E BANNOCK ST, , BOISE, ID, 837126241. The zip code is 837126241.
|Nation Provider ID||1578591210|
|PAC ID by PECOS||2668469925|
|Professional Enrollment ID||I20040428000925|
|Name||BRIAN W GOLTRY|
|Medical School Name||UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE|
|Primary Specialty||PULMONARY DISEASE|
|All secondary specialties|
|Organization Name||ST LUKES CLINIC-TREASURE VALLEY LLC|
|Group Practice PAC ID||4981878402|
|Number of Group Practice members||127|
|Address||190 E BANNOCK ST, , BOISE, ID, 837126241|
|Hospital affiliation LBN||ST LUKES REGIONAL MEDICAL CENTER|