| NPI | 1003157801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY DEE STUCKI President 208-235-4263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0106X Orthopaedic Surgery, Hand Surgery (Licence: ID O-0574) |
| Additional Taxonomies | 207XS0106X Orthopaedic Surgery, Hand Surgery (Licence: ID M-8547) |
| 363AS0400X Physician Assistant, Surgical (Licence: ID PA-684) | |
| Enumeration Date | 2013-03-05 |
| Last Update Date | 2018-08-30 |