Individual
CHARLES FROST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4400 E FLAMINGO AVE, NAMPA, ID 83687-3402
(208) 302-7640
(208) 302-7625
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-7640
(208) 302-7625
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA194
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804051800
—
ID
Enumeration date
06/14/2006
Last updated
11/15/2016
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