Provider Demographics
NPI:1689035404
Name:MALONEY, GREG (PA)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:MALONEY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 191050
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1050
Mailing Address - Country:US
Mailing Address - Phone:208-985-1399
Mailing Address - Fax:208-955-6501
Practice Address - Street 1:1474 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-2041
Practice Address - Country:US
Practice Address - Phone:208-809-2885
Practice Address - Fax:208-809-2886
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2021-12-06
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant