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Individual

KENNETH EDWARD SQUIRES III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
6348 W EMERALD ST, BOISE, ID 83704-8732
(208) 302-0900
(208) 302-0955
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 367-5180

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
O-1978
ID
2084P0800X
Psychiatry Physician
PG183059
OR

Other

Enumeration date
05/02/2017
Last updated
05/15/2024
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