Healthcare Provider Details

I. General information

NPI: 1679717946
Provider Name (Legal Business Name): JACOB MERLIN HARRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST
BOISE ID
83702-4599
US

IV. Provider business mailing address

500 W FORT ST
BOISE ID
83702-4599
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1000
  • Fax: 208-422-1270
Mailing address:
  • Phone: 208-422-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberM-12487
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: