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Kenneth Todd Blackner, MD
General Practice Physician in Shelley, Idaho
NPI 1043339641

Kenneth Todd Blackner is a General Practice Physician based in Shelley, ID. Kenneth Todd Blackner practices in Shelley, ID and has the professional credentials of MD. The NPI Number for Kenneth Todd Blackner is 1043339641 and holds a License No. 0101240258 (Idaho).

The current practice location address for Kenneth Todd Blackner is 275 W Locust St, Shelley, ID and can be reached out via phone at 208-357-3960.

Location: 275 W Locust St, Shelley, ID, 83274-5078
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1043339641
Provider Name
Kenneth Todd Blackner
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
275 W Locust St, Shelley, ID, 83274-5078
Phone Number
208-357-3960
Fax Number
Provider Enumeration Date
03/28/2007
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
275 W Locust St
City
Shelley
State
Idaho
Zip
83274-1230
Phone Number
208-357-3960
Fax Number
person
Provider Business Mailing Address Details
Address
275 W Locust St
City
Shelley
State
Idaho
Zip
83274-1230
Phone Number
208-357-3960
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
208D00000X
License No.
0101240258 (Virginia)
Definition
Definition to come...
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