Individual
JONATHAN B PITTARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
243 CHENEY DR W STE 200, TWIN FALLS, ID 83301-4278
(208) 736-7422
(208) 736-8905
Mailing address
243 CHENEY DR W, TWIN FALLS, ID 83301-4277
(208) 736-7422
(208) 736-8905
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA804
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA804
LICENSE NUMBER
ID
Enumeration date
09/08/2009
Last updated
12/04/2023
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