Organization
IDAHO PAIN MEDICINE, LLP
Active
Organization
IDAHO PAIN MEDICINE, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE ALAN MAXWELL DO (CO-OWNER)
(208) 323-6273
Entity
Organization
Contact information
Practice address
8950 W EMERALD ST STE 168, BOISE, ID 83704-8296
(208) 323-6273
(208) 323-6277
Mailing address
8950 W EMERALD ST STE 168, BOISE, ID 83704-8296
(208) 323-6273
(208) 323-6277
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
02/19/2008
Last updated
02/19/2008
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