Individual
MR. KODIE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2086 PICKET LN, EMMETT, ID 83617-9104
(208) 369-1276
Mailing address
2086 PICKET LN, EMMETT, ID 83617-9104
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9134
AZ
363A00000X
Physician Assistant
—
—
Other
Enumeration date
03/21/2019
Last updated
12/02/2022
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