Individual
LUCAS P BELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
700 E ALICE ST, BLACKFOOT, ID 83221-4925
(208) 785-1200
Mailing address
909 E RESERVE ST, BOISE, ID 83712-6508
(502) 544-1780
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1676
ID
Other
Enumeration date
11/06/2018
Last updated
09/21/2023
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