Healthcare Provider Details

I. General information

NPI: 1790988509
Provider Name (Legal Business Name): JEFFREY L MULERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 ADDISON AVE E SUITE A
TWIN FALLS ID
83301-6749
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-7700
  • Fax: 208-933-9301
Mailing address:
  • Phone: 208-814-7400
  • Fax: 208-814-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM-10252
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: