Individual
KELLY ROGERS SHOWALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
121 E FORT ST, BOISE, ID 83712-6322
(208) 381-1780
Mailing address
121 E. FORT STREET, BOISE, ID 83712
(208) 381-1780
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
M6579
ID
Other
Enumeration date
04/06/2007
Last updated
07/08/2007
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