KENNETH TODD BLACKNER

SHELLEY, ID
NPI1043339641
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy208D00000X General Practice
(Licence: ID  M-11785)
Additional Taxonomies208D00000X General Practice
(Licence: VA  0101240258)
Enumeration Date2007-03-28
Last Update Date2016-02-03
Business Address
-- KENNETH TODD BLACKNER M.D.
275 W LOCUST ST
SHELLEY, ID 83274-1230
Phone number: 208-357-3960
Mailing Address
-- KENNETH TODD BLACKNER M.D.
618 E 1450 N
SHELLEY, ID 83274-5078
Phone number: 757-617-3339