Provider Demographics
NPI:1730276445
Name:SHUEY, DAVID M II (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:SHUEY
Suffix:II
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 1:1102 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-2713
Mailing Address - Country:US
Mailing Address - Phone:208-365-6004
Mailing Address - Fax:208-365-3589
Practice Address - Street 1:1102 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-2713
Practice Address - Country:US
Practice Address - Phone:208-365-6004
Practice Address - Fax:208-365-3589
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-430363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8074378Medicaid
ID000010158621OtherREGENCE BLUE SHIELD OF ID
IDPAD67OtherBLUE CROSS OF IDAHO