Organization
KEZELE ANESTHETICS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN THOMAS KEZELE III CRNA (PRESIDENT)
(208) 852-2019
Entity
Organization
Contact information
Practice address
285 VISTA DR, POCATELLO, ID 83201-4987
(208) 478-1704
Mailing address
104 N BEAR RIVER BLFS, PRESTON, ID 83263-5184
(208) 852-2019
(208) 852-7173
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA-366A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015341
—
ID
Enumeration date
05/12/2015
Last updated
05/12/2015
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