Doctor Name: | DR. LLOYD D STOLWORTHY |
NPI Number: | 1831264878 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | M8815 |
Business Practice Address: | 1130 E Fairview Ave Meridian, ID - 836421813 |
Business Phone Number: | 2088889393 |
Business Fax Number: | 2088889525 |
Mailing Address: | Po Box 191050, BOISE |
State: | ID |
Postal Code: | 837191050 |
Phone Number: | 2089556522 |
Fax Number: | 2089556503 |
NPI Enumeration Date: | 11/22/2006 |
NPI Last Update Date: | 09/10/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | M8815 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |