Basic Information
| Provider Information | |||||||||
| NPI: | 1225448327 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OVERTON | ||||||||
| FirstName: | ERIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 E GOLDSTONE DR | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836421026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083675170 | ||||||||
| FaxNumber: | 2083675180 | ||||||||
| Practice Location | |||||||||
| Address1: | 3217 W BAVARIA ST | ||||||||
| Address2: | |||||||||
| City: | EAGLE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836165171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083026200 | ||||||||
| FaxNumber: | 2083026255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2014 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | M-16769 | ID | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | R74402 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.