Individual
BARTON HILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
M6212
ID
Other
Enumeration date
07/24/2006
Last updated
06/21/2011
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