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General NPI Number Information
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NPI Number | 1124462494
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Entity Type | Organization
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Legal Business Name | UPPER VALLEY ENT & ALLERGY PLLC
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Dates
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Enumeration Date | 04/17/2013
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 256 N 2ND E
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City | REXBURG
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State | ID
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Zip | 83440-1638
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Country | US
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Telephone | 208-656-9646
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Fax | 208-656-9645
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Provider Business Mailing Address
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Address Line | 256 N 2ND E
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City | REXBURG
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State | ID
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Zip | 83440-1638
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Country | US
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Telephone | 208-656-9646
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Fax | 208-656-9645
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Authorized Official
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Title or Position | PHYSICIAN/SURGEON
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Name | DR. JAY ROBERT MCMASTER
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Credential | DO
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Telephone | 208-656-9646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State |
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