Individual
DEREK SCOTT AHLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
7941 W RIFLEMAN ST, BOISE, ID 83704-9001
(208) 895-7950
Mailing address
1650 S TOPAZ WAY, MERIDIAN, ID 83642-4474
(208) 605-7070
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1715
ID
363A00000X
Physician Assistant
PA61522965
WA
Other
Enumeration date
01/08/2019
Last updated
03/28/2024
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