Most Relevant Information
Provider Data
| NPI Number: | 1003325937 |
| Provider Name: | MATTHEW FRANK IVIE PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363AM0700X |
| Specialty: | Physician Assistant |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/22/2017 |
| Last Updated: | 09/22/2017 |
Provider Practice Location
267 N CANYON DR
GOODING
ID
833305500
Practice Location Phone/Fax
| Phone: | 2089344433 |
| Fax: |
Provider Mailing Location
940 E 1400 N
SHELLEY
ID
832745143
Provider Mailing Phone/Fax
| Phone: | 2082069631 |
| Fax: |