Provider Demographics
NPI:1326067604
Name:TURNER, BRETT J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:J
Last Name:TURNER
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 1:7979 W RIFLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9066
Mailing Address - Country:US
Mailing Address - Phone:208-855-2410
Mailing Address - Fax:208-855-0157
Practice Address - Street 1:7979 W RIFLEMAN ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9066
Practice Address - Country:US
Practice Address - Phone:208-855-2410
Practice Address - Fax:208-855-0157
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004189207X00000X, 363A00000X
IDPA-1380363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00246539OtherRR MEDICARE
WA194999OtherLABOR & INDUSTRIES
WA8326225Medicaid
WAG8852689Medicare PIN
WA194999OtherLABOR & INDUSTRIES
194999OtherLABOR & INDUSTRIES