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General NPI Number Information
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NPI Number | 1184189839
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Entity Type | Individual
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Provider Name | ERIC KONKEL PA
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Gender | Male
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Dates
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Enumeration Date | 02/06/2019
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 3399 E LOUISE DR
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City | MERIDIAN
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State | ID
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Zip | 83642-5211
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Country | US
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Telephone | 208-706-2663
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Fax | 208-489-4300
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Provider Business Mailing Address
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Address Line | 3340 E GOLDSTONE DR.
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City | MERIDIAN
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State | ID
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Zip | 83642
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Country | US
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Telephone | 208-302-5950
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Fax | 208-302-5955
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 56475
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-1826
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License Number State | ID
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