NPI 1043180730

Scott Ryan Mangum, PAC

Practitioner Medical Physician Assistant Blackfoot, ID

Practice location

Address: 98 Poplar St, Blackfoot, ID 83221-1799
Phone: (208) 785-4100

Registered specialties

Medical Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AM0700X Licence 7371782 (ID)

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Registry record

NPI: 1043180730
Entity type: Individual
Sex (as registered): Male
NPI issued: 7 Nov 2025
Record last updated: 7 Nov 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.