Individual
SHANE K BALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2094
Mailing address
PO BOX 9696, BOISE, ID 83707-4696
(208) 472-8118
(208) 344-1926
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
M9350
ID
Other
Enumeration date
06/27/2006
Last updated
07/08/2007
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