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General NPI Number Information
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NPI Number | 1760425730
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Entity Type | Individual
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Provider Name | CHARLES FROST PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 4400 E FLAMINGO AVE
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City | NAMPA
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State | ID
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Zip | 83687-3402
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Country | US
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Telephone | 208-302-7640
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Fax | 208-302-7625
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Provider Business Mailing Address
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Address Line | 3340 E GOLDSTONE WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-1026
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Country | US
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Telephone | 208-302-7640
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Fax | 208-302-7625
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA194
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License Number State | ID
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