Bontrager, Gordon Scott

Bontrager, Gordon Scott is an individual health care provider with primary practice located at 465 Memorial Dr , Pocatello ID 83201. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Bontrager, Gordon Scott can be contacted via phone (208) 234-4700.

Contact Information

Primary practice address
465 Memorial Dr Pocatello ID 83201
Phone: (208) 234-4700
Fax: (208) 282-4696
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2119 Tennessee
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MRM-1734 Idaho

Profile Details

NPI number 1780919829
LBN Legal business name Bontrager, Gordon Scott
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 7th, 2009
Last updated Oct 31st, 2023 - about 3 years 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 1780919829 NPPES
Tennessee MEDICAID 15285357
Tennessee MEDICAID 1780919829
Tennessee Other MRM-1734
Tennessee Other P01478459
Tennessee Other PA-2119

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