Search › Idaho › 225200000X
Jason Detwiler
NPI 1275197667 · on the registry since 2019 · sole proprietor
Practice
- Address
- 2411 S Essex Way
Boise, ID 83709 - Phone
- (208) 353-0976
Registry record
- Primary taxonomy
- 225200000X
225200000X
- Licence states on file
- NJ
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2019-05-01
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho