Healthcare Provider Details

I. General information

NPI: 1154370328
Provider Name (Legal Business Name): JEFFREY B. SYMMONDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 W CURTISIAN SUITE 300
BOISE ID
83704
US

IV. Provider business mailing address

3340 EAST GOLDSTONE WAY
MERIDIAN ID
83642-1026
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-7787
  • Fax: 208-367-7798
Mailing address:
  • Phone: 208-367-5170
  • Fax: 208-367-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberM5182
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: