MEDICARE: BRIAN FLOYD WALDRON 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	12457925-1206	UT

General Provider Information

NPI Number	:	1801560354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN FLOYD WALDRON PA-C

Provider Business Mailing Address
First Line	:	2965 E TARPON DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-9009
Country	:	US
Telephone Number	:	208-918-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	2965 E TARPON DR
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-9009
Country	:	US
Telephone Number	:	208-918-2525
Fax Number	:

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

Provider Enumeration Date	:	08/06/2021
Last Update Date	:	05/07/2025

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Directions to “ BRIAN FLOYD WALDRON PA-C” Practice Location

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