Individual
JOSEPH D ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2375 E SUNNYSIDE RD, SUITE J, IDAHO FALLS, ID 83404-8280
(208) 525-4888
Mailing address
2375 E SUNNYSIDE RD, SUITE J, IDAHO FALLS, ID 83404-8280
(208) 525-4888
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA313
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806047800
—
ID
Enumeration date
05/23/2006
Last updated
01/28/2014
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