Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | O-0882 | ID |
N | 2084N0402X | Child Neurologist | 20A7701 | CA |
N | 2084N0402X | Child Neurologist | O-0882 | ID |
NPI | 1144209248 |
---|---|
Provider Name | Dr. Paul William Fleenor |
First Address | Meridian, ID 83642-1026 |
Second Address | Caldwell, ID 83605-4858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 23/03/2016 |