Individual
DR. PAUL ALLEN STANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 227-2850
Mailing address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 227-2850
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M-15729
ID
208M00000X
Hospitalist Physician
M-15729
ID
Other
Enumeration date
04/26/2018
Last updated
08/09/2021
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