# STANLEY J. CHESLOCK, M.D., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376729541
- **Authorized official:** DR. STANLEY J CHESLOCK M.D. (OWNER, PRESIDENT)
- **Authorized official phone:** (208) 529-6430

## Contact information

- **Practice address:** 2860 CHANNING WAY, SUITE 224, IDAHO FALLS, ID 83404-7531
- **Practice address phone:** (208) 529-6430
- **Practice address fax:** (208) 529-6428
- **Mailing address:** 2860 CHANNING WAY, SUITE 224, IDAHO FALLS, ID 83404-7531
- **Mailing address phone:** (208) 529-6430
- **Mailing address fax:** (208) 529-6428

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | M3570 | ID | Yes |

## Other

- **Enumeration date:** 01/17/2008
- **Last updated:** 01/17/2008