Individual
SHAHLA WALIZADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2141 E PARKCENTER BLVD, SAMG BHP FAMILY MEDICINE, BOISE, ID 83706
(208) 302-5000
(208) 302-5025
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-5000
(208) 302-5025
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O0953
ID
Other
Enumeration date
05/21/2013
Last updated
10/20/2016
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