Individual
JOHN TODD ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
700 E ALICE ST, BLACKFOOT, ID 83221-4925
(208) 785-1200
Mailing address
700 E ALICE ST, BLACKFOOT, ID 83221-4925
(208) 785-1200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-999
ID
Other
Enumeration date
10/04/2012
Last updated
10/04/2012
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