Individual
NATHAN T STILLWAGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2963 E COPPER POINT DR, MERIDIAN, ID 83642-9055
(208) 322-1730
Mailing address
2963 E COPPER POINT DR, MERIDIAN, ID 83642-9055
(608) 890-8682
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
M-11728
ID
207P00000X
Emergency Medicine Physician
Primary
MD184107
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/20/2009
Last updated
09/25/2017
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