Individual
DR. RICKY J AXTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3277 E. LOUISE DR., STE. 200, MERIDIAN, ID 83642
(208) 468-5910
(208) 884-2979
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 375-0862
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-10997
ID
Other
Enumeration date
05/03/2007
Last updated
03/23/2023
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