Individual
KLINT HOWARD STANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1202 E LOCAST ST, WALTER KNOX MEMORIAL HOSPITAL, EMMETT, ID 83617
(208) 365-3561
(208) 365-4176
Mailing address
1837 N SUBSTATION RD, EMMETT, ID 83617
(208) 365-7727
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M9508
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010154123
REGENCE BLUE SHIELD IDAHO
ID
01
—
HPAB4
BLUE CROSS IDAHO
ID
Enumeration date
08/30/2006
Last updated
07/08/2007
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