Individual
LANDON MITCHEL FAVERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 E PARKCENTER BLVD, BOISE, ID 83706-6528
(208) 381-6500
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11240954-1206
UT
363A00000X
Physician Assistant
Primary
PA-2428
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
10/31/2018
Last updated
08/22/2023
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