NPI 1265514582

Richard Dale Blickenstaff, MD

Practitioner Procedural Dermatology Physician Boise, ID

Practice location

Address: 6454 W Emerald Street, Boise, ID 83704-8734
Phone: (208) 377-0820

Registered specialties

Procedural Dermatology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207NS0135X Licence M-5274 (ID)

Other Dermatology providers in Idaho →

Registry record

NPI: 1265514582
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Oct 2006
Record last updated: 29 Nov 2007

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.