Healthcare Provider Details

I. General information

NPI: 1225007644
Provider Name (Legal Business Name): SHAYNE C STOKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 LOCUST ST N STE 600
TWIN FALLS ID
83301-4164
US

IV. Provider business mailing address

1502 LOCUST ST N STE 600
TWIN FALLS ID
83301-4164
US

V. Phone/Fax

Practice location:
  • Phone: 208-734-6091
  • Fax:
Mailing address:
  • Phone: 208-734-6091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number21289
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0101234499
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101234499
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberM-15682
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: