Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. RICHARD DALE BLICKENSTAFF, M.D.
Active Sole ProprietorProcedural Dermatology · BOISE, ID
Registration Details
- NPI Number
- 1265514582
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Oct 19, 2006 (19.505852066786 yrs)
- Last Updated
- Nov 29, 2007
- License
-
M-5274 (ID)
- Sole Proprietor
- Yes
Practice Information
- Address
-
6454 W EMERALD STREETBOISE, ID, 837048734Browse ID providers · Browse ZIP 83704
- Phone
- 2083770820
- Primary Specialty
-
Procedural Dermatology
207NS0135X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.