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General NPI Number Information
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NPI Number | 1982037727
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Entity Type | Organization
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Legal Business Name | JON-ERIC BAILLIE, MD PLLC
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 8100 W EMERALD ST STE 180
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 208-377-3299
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Fax | 208-460-5227
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Provider Business Mailing Address
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Address Line | 8100 W EMERALD ST STE 180
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City | BOISE
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State | ID
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Zip | 83704-9069
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Country | US
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Telephone | 208-377-3299
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Fax | 208-460-5227
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | JANENE RAYNE
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Credential | LMSW
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Telephone | 208-377-3299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | M-7882
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License Number State | ID
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