MEDICARE: PAUL JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	M-16790	ID
2	208800000X	Urology Physician	PG205281	OR

General Provider Information

NPI Number	:	1013331172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL JONES

Provider Business Mailing Address
First Line	:	190 E BANNOCK ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83712-6241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 FAIRVIEW AVE STE 350
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-5425
Country	:	US
Telephone Number	:	208-454-9181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2014
Last Update Date	:	08/23/2022

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Directions to “ PAUL JONES ” Practice Location

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