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Individual

SCOTT LACEFIELD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
6641 KANIKSU ST, SUITE A, BONNERS FERRY, ID 83805-7532
(208) 267-3655
(208) 267-3757
Mailing address
6640 KANIKSU ST, BONNERS FERRY, ID 83805-7532
(208) 267-3141
(209) 267-0660

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
594
MT
363A00000X
Physician Assistant
Primary
PA-1184
ID

Other

Enumeration date
10/28/2009
Last updated
09/10/2020
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