CODY CHARLES SMITH

MERIDIAN, ID
NPI1548892110
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: ID  PA-2484)
Additional Taxonomies363A00000X Physician Assistant
(Licence: CA  PA57810)
363AM0700X Physician Assistant, Medical
(Licence: CA  PA57810)
Enumeration Date2020-02-11
Last Update Date2024-08-08
Business Address
Mr. CODY CHARLES SMITH PA
3277 E LOUISE DR FL 2
MERIDIAN, ID 83642-9359
Phone number: 208-381-7335
Mailing Address
Mr. CODY CHARLES SMITH PA
190 E BANNOCK ST
BOISE, ID 83712-6241
Phone number: 208-381-7335