Provider Demographics
NPI:1982857702
Name:FRISBY, SCOTT TREVOR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:TREVOR
Last Name:FRISBY
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:PO BOX 44440
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-0440
Mailing Address - Country:US
Mailing Address - Phone:208-888-1199
Mailing Address - Fax:208-888-0807
Practice Address - Street 1:1525 E LEIGHFIELD DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5371
Practice Address - Country:US
Practice Address - Phone:208-888-1199
Practice Address - Fax:208-888-0807
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7164781-1206363A00000X
IDPA-986363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20007868Medicare UPIN