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Individual

JOSIAH SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
512 E ELM ST, CALDWELL, ID 83605-4871
(208) 370-7004
Mailing address
512 E ELM ST, CALDWELL, ID 83605-4871
(208) 370-7004

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2166
ID
363AM0700X
Medical Physician Assistant
PA-2166
ID
363AM0700X
Medical Physician Assistant
PA939
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100507371
NV
01
100508544
MEDICAID
NV
05
1235100991
NV
Enumeration date
01/31/2006
Last updated
05/15/2024
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