Individual
MICHAEL J SEXTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M6369
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M6369
STATE LICENSE #
ID
Enumeration date
05/19/2006
Last updated
08/19/2012
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