Individual
MICAH RAY TOBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
10583 W LAKE HAZEL RD, BOISE, ID 83709
(208) 302-5950
(208) 302-5955
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 302-5955
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1776
ID
Other
Enumeration date
09/26/2019
Last updated
12/20/2023
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