Individual
MR. AUSTEN REIS CARDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
427 N 12TH ST, PLUMMER, ID 83851
(208) 686-1931
Mailing address
427 12TH STREET/ PO BOX 388, PLUMMER, ID 83851
(208) 686-1931
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1199369
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/01/2021
Last updated
04/26/2024
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