Individual
JASON S PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2301 W A ST, MOSCOW, ID 83843-4038
(208) 883-1135
(208) 892-0174
Mailing address
PO BOX 8007, MOSCOW, ID 83843-0507
(208) 883-1135
(208) 892-0174
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
3549
AZ
363AS0400X
Surgical Physician Assistant
Primary
PA-1735
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167341
—
AZ
Enumeration date
11/16/2006
Last updated
02/27/2026
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