Organization
FALL CREEK SKIN AND HEALTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRETT GERALD BAGLEY P.A.-C. (PHYSICIAN ASSISTANT CERTIFIED)
(208) 359-2263
Entity
Organization
Contact information
Practice address
534 TREJO ST STE 400, REXBURG, ID 83440
(208) 359-2263
(208) 359-2042
Mailing address
PO BOX 378, REXBURG, ID 83440-0378
(208) 359-2263
(208) 359-2042
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-215
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805069800
—
ID
Enumeration date
02/29/2008
Last updated
06/26/2018
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