| Organization Name: | UPPER VALLEY ENT & ALLERGY PLLC |
| NPI Number: | 1124462494 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAY ROBERT MCMASTER (PHYSICIAN/SURGEON) |
| Mailing Address: | 256 N 2nd E Rexburg |
| State: | ID US |
| Postal Code: | 834401638 |
| Phone Number: | 2086569646 |
| Fax Number: | 2086569645 |
| NPI Enumeration Date: | 04/17/2013 |
| NPI Last Update Date: | 06/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207KA0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Allergy & Immunology |
| Taxonomy Specialization: | Allergy |
| Taxonomy Definition: | |