Individual
HARRISON DAVIS BLANTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
315 E ELM STREET, STE 100, CALDWELL, ID 83605-4858
(208) 302-7100
(208) 302-7155
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-7100
(208) 302-7155
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DR0053011
CO
207Q00000X
Family Medicine Physician
M-12857
ID
Other
Enumeration date
04/27/2012
Last updated
07/31/2019
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