Provider Demographics
NPI:1285089144
Name:PARKINSON, BRANT (PA-C)
Entity type:Individual
Prefix:
First Name:BRANT
Middle Name:
Last Name:PARKINSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6235
Mailing Address - Country:US
Mailing Address - Phone:208-538-3122
Mailing Address - Fax:208-561-2998
Practice Address - Street 1:1327 E 17TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6235
Practice Address - Country:US
Practice Address - Phone:208-538-3122
Practice Address - Fax:208-561-2998
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-1369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant