Individual
DANIEL T WHITTED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6590 W NORWOOD DR, BOISE, ID 83704-8765
(208) 855-2410
(208) 855-0157
Mailing address
6590 W NORWOOD DR, BOISE, ID 83704-8765
(208) 855-2410
(208) 855-0157
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-884
ID
363AS0400X
Surgical Physician Assistant
PA-884
ID
Other
Enumeration date
04/12/2011
Last updated
04/12/2011
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