Individual
TRENTON LUCAS PERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
435 S EAGLE RD, EAGLE, ID 83616-6067
(208) 939-8200
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2373
ID
Other
Enumeration date
10/11/2022
Last updated
10/11/2022
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