Healthcare Provider Details

I. General information

NPI: 1487607198
Provider Name (Legal Business Name): JEFFRY P MENZNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 S AMERICANA BLVD SUITE 120
BOISE ID
83702-5099
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-2600
  • Fax: 208-375-2419
Mailing address:
  • Phone: 208-323-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM7573
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberM-7573
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberM-7573
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: