Individual
ANTHONY LICCINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
305 E JEFFERSON ST, BOISE, ID 83712-6231
(208) 345-0715
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8752
(509) 865-5783
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M-16632
ID
208000000X
Pediatrics Physician
MD61058990
WA
Other
Enumeration date
03/27/2017
Last updated
08/19/2022
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