Individual
MASON BRANDON RANKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
6165 W EMERALD ST, BOISE, ID 83704-8613
(208) 302-3500
(208) 302-3555
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 302-9342
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2811
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
08/14/2023
Last updated
06/24/2024
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