Doctor Name: | VICTOR M ISHIDA |
NPI Number: | 1194894113 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.A. |
License Number: | PA423 |
Business Practice Address: | 400 E 7th St Weiser, ID - 836722474 |
Business Phone Number: | 2084148440 |
Business Fax Number: | 2084748442 |
Mailing Address: | 400 E 7th St, WEISER |
State: | ID |
Postal Code: | 836722474 |
Phone Number: | 2084148440 |
Fax Number: | 2084748442 |
NPI Enumeration Date: | 11/06/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA423 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |