Kenneth Todd Blackner, M.D.

NPI #1043339641 in Shelley, Idaho

Provider Information

NPI Number: 1043339641
Entity Type: Individual
Name: Kenneth Todd Blackner, M.D.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: General Practice
Credential: M.D.
Enumeration Date: Mar 28, 2007
Last Updated: Feb 3, 2016

Practice Location

Address: 275 W LOCUST ST
City: Shelley
State: Idaho
ZIP Code: 83274-1230
Phone: (208) 357-3960

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
General Practice	208D00000X	Primary

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