Healthcare Provider Details

I. General information

NPI: 1700154275
Provider Name (Legal Business Name): JACOB SCOTT MAJORS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 S VANGUARD WAY STE 200
MERIDIAN ID
83642-8542
US

IV. Provider business mailing address

PO BOX 191050
BOISE ID
83719-1050
US

V. Phone/Fax

Practice location:
  • Phone: 208-809-2895
  • Fax: 208-809-2896
Mailing address:
  • Phone: 208-985-1423
  • Fax: 208-955-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25883
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25883
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberM-16159
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: