Individual
DONALD E SANFORD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4815 CLEVELAND BLVD, CALDWELL, ID 83605-6501
(208) 455-3545
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1779
ID
Other
Enumeration date
09/18/2019
Last updated
09/18/2019
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