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NPI Code Detail

MEDICARE: PADEN GONZALES

MEDICARE: PADEN GONZALES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA224957OR
2363A00000XPhysician Assistant6361826ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477391357
Entity Type Code : Individual
Provider Name (Legal Business Name) : PADEN GONZALES
Provider Business Mailing Address
First Line : 1441 NE 10TH AVE
Second Line :
City : PAYETTE
State : ID
Zip : 83661-5420
Country : US
Telephone Number : 208-642-9376
Fax Number : 208-642-9279
Provider Business Practice Location Address
First Line : 207 E 12TH ST
Second Line :
City : EMMETT
State : ID
Zip : 83617-3626
Country : US
Telephone Number : 208-365-1065
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2024
Last Update Date : 01/14/2026

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Directions to “ PADEN GONZALES ” Practice Location

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