Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Functional Medicine of Idaho PC

Organization Family Medicine Physician · NPI 1336656040

Functional Medicine of Idaho PC is a Family Medicine Physician in Boise, Idaho. Registered with an NPI since 2018.

In the registry since
2018
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3858 N Garden Center Way Ste 100
Boise, ID 83703-5008
Phone: (208) 385-7711
Fax: (208) 385-0346
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1336656040
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Samuel Warren — President · (208) 385-7711
NPI enumeratedJanuary 3, 2018
Last updated in NPPESJanuary 3, 2018
Mailing address3858 N Garden Center Way Ste 100, Boise, ID 83703-5008

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