Healthcare Provider Details

I. General information

NPI: 1417943622
Provider Name (Legal Business Name): JOHN D JEPPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N CURTIS RD SUITE 100
BOISE ID
83706-1394
US

IV. Provider business mailing address

901 N CURTIS RD SUITE 100
BOISE ID
83706-1394
US

V. Phone/Fax

Practice location:
  • Phone: 208-378-0080
  • Fax: 208-378-0259
Mailing address:
  • Phone: 208-378-0080
  • Fax: 208-378-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberM-6607
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: