Individual provider · Type 1 NPI
Kenneth Todd Blackner, MD
General Practice Physician · Shelley, ID
NPI number
1043339641
Active
Practice location
275 W Locust St
Shelley, ID 83274-1230
Mailing address
618 E 1450 N
Shelley, ID 83274-5078
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| General Practice Physician | 208D00000X | 0101240258 (VA) |
| General Practice Physician Primary | 208D00000X | M-11785 (ID) |
General Practice Physician: A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
2 other providers at this address
About NPI 1043339641
Kenneth Todd Blackner, MD's National Provider Identifier is 1043339641, issued on Mar 28, 2007. The primary taxonomy on file is General Practice Physician (208D00000X), and the practice location is in Shelley, ID. The record was last updated on Feb 3, 2016.