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

Idaho Falls Pediatrics

Organization Pediatric Adolescent Medicine Physician · NPI 1366560971

Idaho Falls Pediatrics is a Pediatric Adolescent Medicine Physician in Ammon, Idaho. Licensed in Idaho. Registered with an NPI since 2007.

Licensed in
ID
In the registry since
2007

Practice location Address checks out

3067 Eagle Dr
Ammon, ID 83406-1273
Phone: (208) 522-4600
Fax: (208) 552-7521
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Adolescent Medicine Physician (primary) Taxonomy 2080A0000X · Licence M7271 (ID)

Record details

NPI number1366560971
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ron Porter — Owner · (208) 522-4600
NPI enumeratedMarch 26, 2007
Last updated in NPPESDecember 5, 2024
Certification dateDecember 5, 2024
Mailing address3067 Eagle Dr, Ammon, ID 83406-1273

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