Individual
STUART KENDALL WILLIS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6640 KANIKSU ST, BONNERS FERRY, ID 83805-7532
(208) 267-4850
(208) 267-2202
Mailing address
HCR 85 BOX 8133, BONNERS FERRY, ID 83805-7532
(208) 267-6365
(208) 267-2202
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M9300
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M9300
ID B OF M
ID
Enumeration date
11/27/2006
Last updated
03/07/2023
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