Individual
KATHLEEN M SCANLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12273 W MCMILLAN RD, BOISE, ID 83713-0555
(208) 367-6330
(208) 367-4765
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5189
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M7309
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003922300
—
ID
Enumeration date
06/11/2006
Last updated
12/31/2008
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