MEDICARE: ANDREW LOGAN BROWER PA-C

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	363A00000X	Physician Assistant	PA-939	ID

General Provider Information

NPI Number	:	1760766976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW LOGAN BROWER PA-C

Provider Business Mailing Address
First Line	:	PO BOX 18
Second Line	:
City	:	SAINT ANTHONY
State	:	ID
Zip	:	83445-0018
Country	:	US
Telephone Number	:	208-356-4900
Fax Number	:	208-624-4112

Provider Business Practice Location Address
First Line	:	335 E MAIN ST STE 1
Second Line	:
City	:	SAINT ANTHONY
State	:	ID
Zip	:	83445-1546
Country	:	US
Telephone Number	:	208-356-4900
Fax Number	:	208-624-4116

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

Provider Enumeration Date	:	10/06/2011
Last Update Date	:	03/11/2024

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Directions to “ ANDREW LOGAN BROWER PA-C” Practice Location

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