Individual
JOHN ERVIN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
700 CALDWELL BLVD, NAMPA, ID 83651-1707
(208) 809-2892
(208) 809-2893
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
(208) 955-6501
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3361575
PHYSICIANS ASSISTANT LICENSE
ID
Enumeration date
06/08/2022
Last updated
02/17/2025
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