Individual
BRYAN G HART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1072 N LIBERTY ST, SUITE 303, BOISE, ID 83704-2800
(208) 367-4035
(208) 367-7111
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-397
ID
363A00000X
Physician Assistant
PA397
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010139458
REGENCE BLUE SHIELD
ID
01
—
0209674
WA DEPARTMENT OF LABOR
WA
01
—
134024
OMAP
OR
01
—
8J190
BLUE CROSS OF IDAHO GROUP
ID
01
—
8J703
BLUE CROSS OF IDAHO GROUP
ID
01
—
PAOV4
BLUE CROSS OF IDAHO
ID
01
—
PAWF2
BLUE CROSS OF IDAHO
ID
Enumeration date
08/09/2006
Last updated
04/23/2014
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