Individual
MR. JAMES PICANCO SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
MISSION ROAD, FORT HALL, ID 83203-0717
(208) 238-5427
(208) 238-5465
Mailing address
MISSION ROAD, FORT HALL, ID 83203-0717
(208) 238-5427
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01153
TX
Other
Enumeration date
08/01/2006
Last updated
07/18/2007
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