Individual
MR. DANIEL JAMES COUNCELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
500 W FORT ST, BOISE, ID 83702-4501
(208) 422-1000
Mailing address
1106 N 15TH ST, BOISE, ID 83702-3401
(828) 551-6356
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/11/2020
Last updated
09/11/2020
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