Individual
THOMAS WAYNE TRYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
206 E ELM ST, CALDWELL, ID 83605-4815
(208) 459-4511
(208) 459-6602
Mailing address
1031 W YOSEMITE DR, MERIDIAN, ID 83642-2598
(208) 898-0845
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA414
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806483200
—
ID
Enumeration date
05/09/2006
Last updated
10/14/2010
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