KOVIC SHANE BAILEY DO
Individual Provider (NPI-1)
Active
Family Medicine
Provider Information
- NPI Number
1194467688- Provider Type
- Individual Provider (NPI-1)
- Credentials
- DO
- Status
- Active
Contact & Location
- Address
- 775 POLE LINE RD W, TWIN FALLS, ID, 833015814
- Phone
- (208) 814-8000
- Fax
- (208) 733-9402
Specialties & Taxonomies
Student in an Organized Health Care Education/Training Program
License: TX #BP10080618
Family Medicine
Primary License: ID #7771540
All Addresses
MAILING
190 E BANNOCK ST
BOISE, ID, 837126241