Provider Demographics
NPI:1184097370
Name:VALORA, PETER J (PA)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:J
Last Name:VALORA
Suffix:
Gender:
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 18
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:ID
Mailing Address - Zip Code:83445-0018
Mailing Address - Country:US
Mailing Address - Phone:208-356-4900
Mailing Address - Fax:208-624-4112
Practice Address - Street 1:72 S 1ST E STE 101
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1965
Practice Address - Country:US
Practice Address - Phone:208-356-4900
Practice Address - Fax:208-356-3724
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA-1321363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant