Individual
DR. RICHARD DALE BLICKENSTAFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6454 W EMERALD STREET, BOISE, ID 83704-8734
(208) 377-0820
Mailing address
6454 W EMERALD STREET, BOISE, ID 83704-8734
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
M-5274
ID
Other
Enumeration date
10/19/2006
Last updated
11/29/2007
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