Individual
MICHAEL RAY HASKELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
120 EAST HOWARD AVENUE, TETON VALLEY HEALTH CARE, DRIGGS, ID 83422-5112
(208) 354-6302
(208) 354-3158
Mailing address
120 EAST HOWARD AVENUE, TETON VALLEY HEALTH CARE, DRIGGS, ID 83422-5112
(208) 354-6352
(208) 354-3158
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
576
WY
363AS0400X
Surgical Physician Assistant
576
WY
Other
Enumeration date
04/13/2013
Last updated
12/14/2016
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