Individual
KEVIN MATTHEW HANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1582 ELK CREEK DRIVE, IDAHO FALLS, ID 83404
(208) 542-5414
(208) 552-2708
Mailing address
1582 ELK CREEK DRIVE, IDAHO FALLS, ID 83404
(208) 542-5414
(208) 552-2708
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
0-0401
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80756400
—
ID
Enumeration date
07/31/2006
Last updated
06/05/2013
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