Individual
LEILA KHADDOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3123 MEDICAL DR, CALDWELL, ID 83605-6972
(208) 367-3131
(208) 367-4817
Mailing address
3340 E GOLDSTONE DR, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301105339
MI
207RX0202X
Medical Oncology Physician
4301105339
MI
207RX0202X
Medical Oncology Physician
Primary
MC-0480
ID
Other
Enumeration date
07/02/2014
Last updated
07/21/2022
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