Individual
VICTOR M ISHIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
910 NW 16TH ST STE 101, FRUITLAND, ID 83619-2265
(208) 452-8050
(208) 452-8055
Mailing address
910 NW 16TH ST STE 101, FRUITLAND, ID 83619-2265
(208) 452-8050
(208) 452-8055
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA423
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805922100
—
OR
Enumeration date
11/06/2006
Last updated
06/10/2022
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