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General NPI Number Information
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NPI Number | 1447483086
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Entity Type | Individual
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Provider Name | MATTHEW VALLEY PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 1605 E RIVERSIDE DR
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City | EAGLE
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State | ID
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Zip | 83616-6237
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Country | US
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Telephone | 208-939-6227
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Fax | 208-939-6442
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Provider Business Mailing Address
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Address Line | 1605 E RIVERSIDE DR
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City | EAGLE
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State | ID
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Zip | 83616-6237
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Country | US
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Telephone | 208-939-6227
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Fax | 208-939-6442
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA-809
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License Number State | ID
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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 | PA-809
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License Number State | ID
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