Individual
NOAH BERNAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3614 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7573
(208) 535-4343
Mailing address
6410 E MANSION HILL DR, AMMON, ID 83406-4707
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
PA-1924
ID
363AM0700X
Medical Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/03/2019
Last updated
08/21/2024
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