# UPPER VALLEY ENT & ALLERGY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124462494
- **Authorized official:** DR. JAY ROBERT MCMASTER DO (PHYSICIAN/SURGEON)
- **Authorized official phone:** (208) 656-9646

## Contact information

- **Practice address:** 256 N 2ND E, REXBURG, ID 83440-1638
- **Practice address phone:** (208) 656-9646
- **Practice address fax:** (208) 656-9645
- **Mailing address:** 256 N 2ND E, REXBURG, ID 83440-1638
- **Mailing address phone:** (208) 656-9646
- **Mailing address fax:** (208) 656-9645

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207KA0200X | Allergy Physician | — | — | — |
| 207YX0905X | Otolaryngology/Facial Plastic Surgery Physician | — | — | Yes |
| 363AM0700X | Medical Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 04/17/2013
- **Last updated:** 06/11/2014