Individual
TYLER HEPWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
777 HOSPITAL WAY, POCATELLO, ID 83201-5175
(480) 421-9700
(480) 421-9899
Mailing address
PO BOX 15070, SCOTTSDALE, AZ 85267-5070
(480) 421-9700
(480) 421-9899
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-907
ID
Other
Enumeration date
04/26/2011
Last updated
07/19/2011
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