Healthcare Provider Details

I. General information

NPI: 1962817049
Provider Name (Legal Business Name): MATTHEW JOSEPH PARRY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 S 8TH ST
ASHTON ID
83420-5211
US

IV. Provider business mailing address

535 W SUNNYSIDE RD
IDAHO FALLS ID
83402-4643
US

V. Phone/Fax

Practice location:
  • Phone: 208-330-3007
  • Fax: 800-861-3329
Mailing address:
  • Phone: 208-357-9700
  • Fax: 208-963-3245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberO-0852
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: