SHANE KEITH ANDERSON

MALAD CITY, ID
NPI1841289659
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy207R00000X Internal Medicine
(Licence: MT  11818)
Additional Taxonomies207R00000X Internal Medicine
(Licence: MO  2004001424)
Enumeration Date2005-10-14
Last Update Date2011-05-24
Business Address
Dr. SHANE KEITH ANDERSON D.O.
220 BANNOCK ST
MALAD CITY, ID 83252-1256
Phone number: 208-766-2600
Mailing Address
Dr. SHANE KEITH ANDERSON D.O.
PO BOX 126
MALAD CITY, ID 83252-0126
Phone number: 208-766-2231