State of Idaho
NPI #1790841781 in Blackfoot, Idaho
Provider Information
- NPI Number
- 1790841781
- Entity Type
- Organization
- Organization Name
- State of Idaho
- Primary Specialty
- Clinical Medical Laboratory
- Enumeration Date
- Dec 28, 2006
- Last Updated
- Aug 22, 2020
Practice Location
Authorized Official
- Name
- RALPH DUANE HECKARD, M.D.
- Title
- MEDICAL DIRECTOR
- Phone
- (208) 785-8429
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinical Medical Laboratory |
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