Provider Demographics
NPI:1780965038
Name:MEREDITH, REX ALLEN (PA-C)
Entity type:Individual
Prefix:MR
First Name:REX
Middle Name:ALLEN
Last Name:MEREDITH
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:37 S 2ND E
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1906
Mailing Address - Country:US
Mailing Address - Phone:208-356-0234
Mailing Address - Fax:208-656-8444
Practice Address - Street 1:393 E 2ND N
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1605
Practice Address - Country:US
Practice Address - Phone:208-359-6781
Practice Address - Fax:208-356-3111
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2021-06-01
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Provider Licenses
StateLicense IDTaxonomies
IDPA-923363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical