Individual
MERRICK GORDON REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
526 SHOUP AVE W, SUITE E, TWIN FALLS, ID 83301-5050
(208) 733-1112
(208) 732-1212
Mailing address
526 SHOUP AVE W, SUITE E, TWIN FALLS, ID 83301-5050
(208) 733-1112
(208) 732-1212
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA876
ID
Other
Enumeration date
11/17/2010
Last updated
11/17/2010
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