Provider Demographics
NPI:1508855974
Name:PERMANN, SETH ALAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:ALAN
Last Name:PERMANN
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 1:318 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3765
Mailing Address - Country:US
Mailing Address - Phone:208-467-3006
Mailing Address - Fax:208-467-1155
Practice Address - Street 1:318 2ND ST S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3765
Practice Address - Country:US
Practice Address - Phone:208-467-3006
Practice Address - Fax:208-467-1155
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1667206OtherMEDICARE
ID807287300Medicaid
IDQ55656Medicare UPIN