Individual
JOHN LAURENT ETCHETO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
176 FALLS AVENUE, TWIN FALLS, ID 83301
(208) 733-3181
(208) 733-3168
Mailing address
1740 BROOKFIELD CT, TWIN FALLS, ID 83301-3562
(208) 736-2399
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-476
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806757300
—
ID
Enumeration date
07/11/2006
Last updated
05/06/2024
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