MEDICARE: JACOB MERLIN HARRIS M.D.

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	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	M-12487	ID

General Provider Information

NPI Number	:	1679717946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB MERLIN HARRIS M.D.

Provider Business Mailing Address
First Line	:	500 W FORT ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-4599
Country	:	US
Telephone Number	:	208-422-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W FORT ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-4599
Country	:	US
Telephone Number	:	208-422-1000
Fax Number	:	208-422-1270

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

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	11/24/2025

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