Individual provider · Type 1 NPI
Scott Ryan Mangum, PA-C
Medical Physician Assistant · Blackfoot, ID
NPI number
1043180730
Active
Practice location
98 Poplar St
Blackfoot, ID 83221-1799
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | 7371782 (ID) |
Medical Physician Assistant: Definition to come...
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About NPI 1043180730
Scott Ryan Mangum, PA-C's National Provider Identifier is 1043180730, issued on Nov 7, 2025. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Blackfoot, ID. The record was last updated on Nov 7, 2025.