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General NPI Number Information
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NPI Number | 1467212050
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Entity Type | Individual
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Provider Name | JACOB MILLER TADJE
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Gender | Male
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | UNIVERSITY OF VERMONT MEDICAL CENTER
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City | BURLINGTON
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State | VT
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Zip | 05405-0001
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Country | US
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Telephone | 802-656-3806
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 N TIMBER RIDGE LN
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City | EAGLE
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State | ID
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Zip | 83616-5619
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Country | US
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Telephone | 208-995-3616
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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