Individual
MR. KOLT MONTE PIQUET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1675 CURLEW DR, AMMON, ID 83406-4850
(208) 523-5319
(208) 523-5627
Mailing address
1675 CURLEW DR, AMMON, ID 83406-4850
(208) 523-5319
(208) 523-5627
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1539
ID
Other
Enumeration date
10/05/2017
Last updated
10/05/2017
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