Individual
STEVEN J FONKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 W. FORT ST, # 111, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Mailing address
500 W. FORT ST, # 111, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
M-7934
ID
207RC0000X
Cardiovascular Disease Physician
Primary
M-7934
ID
207RI0011X
Interventional Cardiology Physician
M-7934
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010027675
REGENCE BLUE SHIELD OF ID
—
01
—
59923
BLUE CROSS OF IDAHO
—
05
—
805658400
—
ID
Enumeration date
07/13/2006
Last updated
03/01/2022
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