Anderson, Kerry W

Anderson, Kerry W is an individual health care provider with primary practice located at 809 N Liberty St , Boise ID 83704-8703. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Anderson, Kerry W can be contacted via phone (208) 327-0627.

Contact Information

Primary practice address
809 N Liberty St Boise ID 83704-8703
Phone: (208) 327-0627
Fax: (208) 376-5258
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X P144 Idaho

Profile Details

NPI number 1659310829
LBN Legal business name Anderson, Kerry W
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 5th, 2006
Last updated Mar 1st, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659310829 NPPES
Idaho MEDICAID 004395700

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