Individual
MATTHEW THOMAS CARR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
211 FOREST ST, MCCALL, ID 83638-5256
(208) 634-2225
(208) 634-7212
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2632
ID
Other
Enumeration date
12/12/2023
Last updated
02/19/2024
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