Individual
DR. ERIC GERAND STACKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2429 NORTH COLE ROAD, BOISE, ID 83704-5907
(208) 377-4190
(208) 358-9157
Mailing address
2429 NORTH COLE ROAD, BOISE, ID 83704-5907
(208) 377-4190
(208) 358-9157
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M3313
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1110175
—
ID
Enumeration date
08/31/2006
Last updated
07/08/2007
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