Individual
BRYCE LEONARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1130 E FAIRVIEW AVE, MERIDIAN, ID 83642-1813
(208) 888-9393
(208) 888-9525
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1309
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/16/2014
Last updated
10/13/2015
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