NPI 1043339641

Kenneth Todd Blackner, MD

Practitioner General Practice Physician Shelley, ID

Practice location

Address: 275 W Locust St, Shelley, ID 83274-1230
Phone: (208) 357-3960
Mailing address: 618 E 1450 N, Shelley, ID 83274-5078

Registered specialties (2)

General Practice Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208D00000X Licence M-11785 (ID)

Other General Practice providers in Idaho →

General Practice Physician

Allopathic & Osteopathic Physicians Taxonomy 208D00000X Licence 0101240258 (VA)

Registry record

NPI: 1043339641
Entity type: Individual
Sex (as registered): Male
NPI issued: 28 Mar 2007
Record last updated: 3 Feb 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.