Individual
JOHN CLARK MAYBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1906 FAIRVIEW AVE STE 130, CALDWELL, ID 83605-5433
(208) 453-4260
(844) 213-3678
Mailing address
PO BOX 1074, CALDWELL, ID 83606-1074
(208) 453-4260
(844) 213-3678
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M-12108
ID
2086S0102X
Surgical Critical Care Physician
M-12108
ID
Other
Enumeration date
08/01/2006
Last updated
10/03/2023
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