=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649321134
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID L DAY P.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2007
-----------------------------------------------------
Last Update Date | 09/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32 W 1ST S
-----------------------------------------------------
City | REXBURG
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83440-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-356-7585
-----------------------------------------------------
Fax | 208-356-7566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 JERRY LN
-----------------------------------------------------
City | REXBURG
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83440-3586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-359-0621
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | PA394
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------