Individual
SAMUEL ROBERT STONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4300 E FLAMINGO AVE, NAMPA, ID 83687-3138
(208) 205-1100
Mailing address
921 S 8TH AVE STOP 8253, POCATELLO, ID 83209-0002
(208) 282-4726
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2335
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/12/2022
Last updated
09/21/2022
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