Individual
ROBERT BLACKSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CST, CSFA
Contact information
Practice address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-4000
Mailing address
4768 W PRINCETOWN LN, COEUR D ALENE, ID 83815-5215
(208) 961-1151
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
143020
ID
Other
Enumeration date
12/05/2006
Last updated
04/26/2018
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