| Doctor Name: | MR. BRADLEY JAMES HENINGER |
| NPI Number: | 1205103389 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | |
| Business Practice Address: | 910 Nw 16th Street Ste 205 Fruitland, ID - 83619 |
| Business Phone Number: | 2084523111 |
| Business Fax Number: | 2084523666 |
| Mailing Address: | 3340 E Goldstone Way, MERIDIAN |
| State: | ID |
| Postal Code: | 836421026 |
| Phone Number: | 2084523111 |
| Fax Number: | 2084523666 |
| NPI Enumeration Date: | 11/17/2011 |
| NPI Last Update Date: | 02/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |