Individual
KIPP B WEBB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2985 CORTEZ AVE, IDAHO FALLS, ID 83404-2985
(208) 523-3373
(208) 523-8746
Mailing address
2001S WOODRUFF AVE STE 3, IDAHO FALLS, ID 83404-6371
(208) 523-3050
(208) 523-4985
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
6084
MT
207RC0000X
Cardiovascular Disease Physician
Primary
M-12781
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
63479
—
MT
Enumeration date
11/18/2009
Last updated
09/17/2015
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