MEDICARE: JEFF CONLON

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1174068282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF CONLON

Provider Business Mailing Address
First Line	:	12290 W GREGORY DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-6523
Country	:	US
Telephone Number	:	208-598-0080
Fax Number	:

Provider Business Practice Location Address
First Line	:	12290 W GREGORY DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-6523
Country	:	US
Telephone Number	:	208-598-0080
Fax Number	:

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

Provider Enumeration Date	:	12/28/2016
Last Update Date	:	12/28/2016

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Directions to “ JEFF CONLON ” Practice Location

Language	Start Address	Practice Location

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