Kenneth Todd Blackner, MD
Kenneth Todd Blackner, MD is a General Practice Physician in Shelley, Idaho. Practices as a sole proprietor. Licensed in Idaho and Virginia.
- Licensed in
- ID, VA
- In the registry since
- 2007
- Specialties on file
- 2
What do these letters mean?
- MD — Doctor of Medicine
- A physician who completed allopathic medical school.
Practice location Address checks out
275 W Locust StShelley, ID 83274-1230
Phone: (208) 357-3960
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| General Practice Physician (primary) | Taxonomy 208D00000X · Licence M-11785 (ID) |
|---|---|
| General Practice Physician | Taxonomy 208D00000X · Licence 0101240258 (VA) |
Record details
| NPI number | 1043339641 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | MD |
| Sole proprietor | Yes |
| NPI enumerated | March 28, 2007 |
| Last updated in NPPES | February 3, 2016 |
| Mailing address | 618 E 1450 N, Shelley, ID 83274-5078 |