Healthcare Provider Details

I. General information

NPI: 1245692813
Provider Name (Legal Business Name): JAVIER JARAMILLO MORALES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 W GAGE ST STE A
BOISE ID
83706-1332
US

IV. Provider business mailing address

7733 BROOK GLEN WAY
NASHVILLE TN
37221-4112
US

V. Phone/Fax

Practice location:
  • Phone: 208-501-8955
  • Fax:
Mailing address:
  • Phone: 801-824-9976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberM-16628
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: