Healthcare Provider Details

I. General information

NPI: 1295951382
Provider Name (Legal Business Name): WEST JEFFERSON FAMILY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 N. 8TH W
SAINT ANTHONY ID
83445
US

IV. Provider business mailing address

39 N. 8TH W
SAINT ANTHONY ID
83445
US

V. Phone/Fax

Practice location:
  • Phone: 208-419-6423
  • Fax: 208-379-3520
Mailing address:
  • Phone: 208-419-6423
  • Fax: 208-379-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberID-197
License Number StateID

VIII. Authorized Official

Name: BRETT W ZUNDEL
Title or Position: OWNER/PROVIDER
Credential: PA-C
Phone: 208-419-6423