Provider Demographics
NPI:1164152336
Name:HOUSE, GERAD CLINTON (PA-C)
Entity Type:Individual
Prefix:
First Name:GERAD
Middle Name:CLINTON
Last Name:HOUSE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 S INGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-4628
Mailing Address - Country:US
Mailing Address - Phone:208-484-8238
Mailing Address - Fax:
Practice Address - Street 1:2906 S INGLEWOOD RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-4628
Practice Address - Country:US
Practice Address - Phone:208-484-8238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-12
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty