Blackner, Kenneth Todd

Blackner, Kenneth Todd is an sole proprietor health care provider with primary practice located at 275 W Locust St , Shelley ID 83274-1230. He recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as his primary health care specialty. Blackner, Kenneth Todd can be contacted via phone (208) 357-3960.

Contact Information

Primary practice address
275 W Locust St Shelley ID 83274-1230
Phone: (208) 357-3960
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 0101240258 Virginia
Allopathic & Osteopathic Physicians / General Practice 208D00000X M-11785 Idaho

Profile Details

NPI number 1043339641
LBN Legal business name Blackner, Kenneth Todd
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 28th, 2007
Last updated Feb 3rd, 2016 - about 9 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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