MEDICARE: JEFFRY P MENZNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	M7573	ID
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	M-7573	ID
3	207XX0801X	Orthopaedic Trauma Physician	M-7573	ID

General Provider Information

NPI Number	:	1487607198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFRY P MENZNER MD

Provider Business Mailing Address
First Line	:	190 E BANNOCK ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83712-6241
Country	:	US
Telephone Number	:	208-323-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 S AMERICANA BLVD
Second Line	:	SUITE 120
City	:	BOISE
State	:	ID
Zip	:	83702-5099
Country	:	US
Telephone Number	:	208-323-2600
Fax Number	:	208-375-2419

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	10/17/2013

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Directions to “ JEFFRY P MENZNER MD” Practice Location

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