Individual
JACOB VIAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
525 S CENTER ST, REXBURG, ID 83460-0004
(406) 595-1515
Mailing address
651 S 2400 W UNIT 11102, REXBURG, ID 83440-5484
(406) 595-1515
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2557
ID
Other
Enumeration date
08/29/2022
Last updated
09/12/2023
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