Individual
LOGAN HILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1907 S BROADWAY AVE STE 100, BOISE, ID 83706-4228
(208) 345-1222
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1988
ID
Other
Enumeration date
01/04/2021
Last updated
07/20/2021
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