St Clair Specialty Physicians
St Clair Specialty Physicians is a Nephrology Physician in Boise, Idaho. Registered with an NPI since 2011.
- In the registry since
- 2011
Practice location Address checks out
5610 Gage St Ste ABoise, ID 83706
Phone: (208) 367-3370
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Nephrology Physician (primary) | Taxonomy 207RN0300X |
|---|
Record details
| NPI number | 1063719292 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Robert Provenzano — President/Partner · (313) 886-8787 |
| NPI enumerated | February 24, 2011 |
| Last updated in NPPES | February 24, 2011 |
| Mailing address | 45640 Schoenherr Road, Shelby Twp, MI 48315 |
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Dr. Jon Parker Wagnild, MD
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