Healthcare Provider Details

I. General information

NPI: 1467973826
Provider Name (Legal Business Name): JEFFREY SAMUEL URE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 CHENEY DR W STE 200
TWIN FALLS ID
83301-3721
US

IV. Provider business mailing address

243 CHENEY DR W STE 200
TWIN FALLS ID
83301-3721
US

V. Phone/Fax

Practice location:
  • Phone: 208-736-7422
  • Fax:
Mailing address:
  • Phone: 208-736-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA188117
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: