MEDICARE: TROY D WESTON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA212	ID
2	363A00000X	Physician Assistant	PA 212	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PASRO	OTHER	ID	BLUE CROSS

General Provider Information

NPI Number	:	1396715371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TROY D WESTON PA

Provider Business Mailing Address
First Line	:	120 E HOWARD ST
Second Line	:	TETON VALLEY HEALTH CARE
City	:	DRIGGS
State	:	ID
Zip	:	83422-5112
Country	:	US
Telephone Number	:	208-354-6302
Fax Number	:	208-354-3158

Provider Business Practice Location Address
First Line	:	120 E HOWARD ST
Second Line	:	TETON VALLEY HEALTH CARE
City	:	DRIGGS
State	:	ID
Zip	:	83422-5112
Country	:	US
Telephone Number	:	208-354-6302
Fax Number	:	208-354-3158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	11/04/2016

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Directions to “ TROY D WESTON PA” Practice Location

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