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NPI Code Detail

MEDICARE: GREG LYLE KLINGLER PA-C

MEDICARE: GREG LYLE KLINGLER PA-C
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
1363AM0700XMedical Physician AssistantPA-836ID

General Provider Information

NPI Number : 1972770881
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREG LYLE KLINGLER PA-C
Provider Business Mailing Address
First Line : 32 W 1ST S
Second Line :
City : REXBURG
State : ID
Zip : 83440-1810
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 32 W 1ST S
Second Line :
City : REXBURG
State : ID
Zip : 83440-1810
Country : US
Telephone Number : 208-356-7585
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2008
Last Update Date : 01/25/2010

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Directions to “ GREG LYLE KLINGLER PA-C” Practice Location

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