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NPI Profile for BRADLEY J HENINGER in FRUITLAND, ID.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Medical |
363AM0700X | 97 | Physician Assistant |
| NPI Number | 1205103389 |
|
| Status | Active | |
| Credentials | PA-C (Physician Assistant-Certified) | |
| Entity | Individual | |
| Enumeration date | 11/17/2011 | |
| Last updated | 02/17/2016 - About 10 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
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| Hospital affiliation(s) |
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BRADLEY J HENINGER
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BRADLEY J HENINGER, PA-C