Individual
PHILIP C HESSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2377 CORONADO ST, IDAHO FALLS, ID 83404-7440
(208) 557-2570
Mailing address
PO BOX 1647, IDAHO FALLS, ID 83403-1647
(208) 535-4130
(208) 535-4125
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA87
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806633300
—
ID
01
—
PASPA
BLUE CHOICE
ID
Enumeration date
01/05/2006
Last updated
01/10/2019
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