Provider Demographics
NPI:1851349914
Name:FOLLETT, STEVEN LARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LARRY
Last Name:FOLLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4205
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4205
Mailing Address - Country:US
Mailing Address - Phone:208-241-4204
Mailing Address - Fax:208-234-1162
Practice Address - Street 1:1749 WALKABOUT DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-7015
Practice Address - Country:US
Practice Address - Phone:208-241-4204
Practice Address - Fax:208-234-1162
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD180303207L00000X
IDM-6951207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20002355OtherMEDICARE ID
ID1851349914Medicaid
ID20002355OtherMEDICARE ID