Individual
BLAINE GIBBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
730 N COLLEGE RD STE A&B, TWIN FALLS, ID 83301-3416
(208) 814-8000
(208) 933-4919
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
12127
SD
207Q00000X
Family Medicine Physician
Primary
O-1940
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013443555
—
SD
Enumeration date
05/03/2017
Last updated
05/01/2024
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