Healthcare Provider Details

I. General information

NPI: 1437166550
Provider Name (Legal Business Name): ROY A STERNES PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E HAWAII AVENUE
NAMPA ID
83186
US

IV. Provider business mailing address

217 W GEORGIA SUITE 115
NAMPA ID
83686
US

V. Phone/Fax

Practice location:
  • Phone: 208-463-3000
  • Fax: 208-463-3034
Mailing address:
  • Phone: 208-463-3000
  • Fax: 208-463-3034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA207
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: