Individual
MR. MATTHEW FRANK IVIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
267 N CANYON DR, GOODING, ID 83330-5500
(208) 934-4433
Mailing address
940 E 1400 N, SHELLEY, ID 83274-5143
(208) 206-9631
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
ID
Other
Enumeration date
09/22/2017
Last updated
09/22/2017
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