Individual
BASIL CLARENCE ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
132 MAIN ST N, KIMBERLY, ID 83341
(208) 735-3938
(208) 735-3939
Mailing address
794 EASTLAND DR, TWIN FALLS, ID 83301-6856
(208) 734-3312
(208) 734-5036
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
A120404
CA
207Q00000X
Family Medicine Physician
Primary
M-11966
ID
207Q00000X
Family Medicine Physician
MD154424
OR
390200000X
Student in an Organized Health Care Education/Training Program
STUDENT
—
Other
Enumeration date
04/07/2010
Last updated
11/16/2024
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