Individual
ANTHONY R BERRETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-4100
Mailing address
2730 CHANNING WAY, IDAHO FALLS, ID 83404-5049
(208) 542-7100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/09/2016
Last updated
09/16/2024
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