Individual
MANUEL SIERRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1740 E 17TH ST, SUITE A, IDAHO FALLS, ID 83404-6375
(208) 346-7500
Mailing address
300 VALLEYVIEW DR, POCATELLO, ID 83204-4708
(208) 244-2707
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
A85395
CA
2084P0804X
Child & Adolescent Psychiatry Physician
227980
MA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
M10460
ID
Other
Enumeration date
02/19/2006
Last updated
05/28/2009
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